Faculty Scholarship

Background: Some chiropractors use spinal x-rays to inform care, but the relationship between radiographic findings and outcomes is unclear. This study examined the association between radiographic findings and 30% improvement in back-related disability in older adults after receiving 12 weeks of chiropractic spinal manipulation and home exercise instruction.

Methods: This IRB-approved secondary analysis used randomized trial data of community-dwelling adults age ≥ 65 with chronic spinal pain and disability. Data were collected during the parent trial between January 2010-December 2014. The primary outcome of the parent study was ≥ 30% improvement in Oswestry Disability Index (ODI) at 12 weeks, a clinically important response to care. In this secondary analysis, two chiropractic radiologists independently assessed digital lumbar radiographs for pre-specified anatomic, degenerative, and alignment factors; differences were adjudicated. The unadjusted association between baseline radiographic factors and 30% ODI improvement was determined using chi-square tests.

Results: From the parent trial, 120 adults with baseline lumbar radiographs were included in this study. Mean age was 70.4 years (range 65–81); 59.2% were female. Mean baseline disability (ODI = 25.6) and back pain (5.2, 0–10 scale) were moderate. Disc degeneration (53.3% moderate, 13.3% severe), anterolisthesis (53.3%), retrolisthesis (36.6%) and scoliosis (35.0%) were common among the participant sample. After 12-weeks of treatment, 51 (42.5%) participants achieved 30% improvement in back disability. No alignment, degenerative, or anatomic factors were associated with ODI improvement at 12 weeks (all p > 0.05), regardless of severity of radiographic findings.

Conclusion: We found no association between a predetermined subset of radiographic findings and improvement in back-related disability among this sample of older adults. As such, this study provides preliminary data suggesting that imaging may be unhelpful for predicting response to chiropractic spinal manipulation and home exercise.

Settlements from lawsuits against some of the largest companies at the center of the opioid
crisis will generate over $50 billion over the next 18 years. Recently published
recommendations from RAND advocate using funds to increase public awareness and
patient access to nonpharmacological therapies, including chiropractic care. Attendees will
explore a range of opportunities to leverage settlement funding to support non-opioid pain
management in their communities, and position chiropractic as an upstream prevention
strategy in the ongoing opioid epidemic.

Settlements from lawsuits against some of the largest companies at the center of the opioid crisis will generate over $50 billion over the next 18 years. Recently published recommendations from RAND advocate using funds to increase public awareness and patient access to nonpharmacological therapies, including chiropractic care. Attendees will explore a range of opportunities to leverage settlement funding to support non-opioid pain management in their communities, and position chiropractic as an upstream prevention strategy in the ongoing opioid epidemic.

Opioid-related lawsuits are expected to generate more than $50 billion in settlement funds for states and localities to remediate the catastrophic consequences of the opioid crisis. Guidance on the distribution of settlement funds has primarily focused on reducing opioid-related deaths and other opioid-related harms and on improving treatment for substance use disorders. However, an effective approach to this crisis will also require primary prevention strategies to reduce unnecessary opioid initiation, particularly through effective pain management. Although numerous strategies have been implemented to slow the issuance of opioid prescriptions, little attention has been given to providing effective nonopioid alternatives for people in pain at the point when they initially seek care. This lack of a preventive focus represents a dangerous gap given that pain remains a leading reason people seek health care.

Chiropractors often boast about high patient satisfaction, good clinical outcomes, and “always” having been patient-centered. While evidence supports those claims, it is worthwhile for us to pause and ask, “what does it take to be person-centered?”, especially given a dynamic and increasingly complex 21st-century social and healthcare climate. As with all aspects of patient care, revisiting the behaviors, skills, and competencies relative to person-centered care through the lens of contemporary best practices can result in better quality, high value care for the communities we serve.

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.
Results: 201 participants were enrolled. The largest reductions in pain intensity occurred at the end of treatment and were 43% for CC and 47% for IC. The primary analysis found IC to be significantly superior to CC over the 1-year period (P = 0.02). The long-term profile for pain intensity which included data from weeks 4 through 52, showed a significant advantage of 0.5 for IC over CC (95% CI 0.1 to 0.9; P = 0.02; 0 to 10 scale). The short-term profile (weeks 4 to 12) favored IC by 0.4, but was not statistically significant (95% CI − 0.02 to 0.9; P = 0.06). There was also a significant advantage over the long term for IC in some secondary measures (disability, improvement, satisfaction and low back symptom frequency), but not for others (medication use, quality of life, leg symptom frequency, fear avoidance beliefs, self- efficacy, active pain coping, and kinesiophobia). Importantly, no serious adverse events resulted from either of the interventions.
Conclusions: Participants in the IC group tended to have better outcomes than the CC group, however the magnitude of the group differences was relatively small. Given the resources required to successfully implement multidisciplinary integrative care teams, they may not be worthwhile, compared to monodisciplinary approaches like chiropractic care, for treating LBP.

Chiropractic educational programs include content related to topics broadly characterized under the heading of “public health”. That content is driven, at least to some degree, by common educational accreditation requirements and licensing board test plans, particularly in the United States. However, despite those external drivers, significant disparity exists between chiropractic programs regarding the content and delivery of public health topics. Attempts have been made to identify standardized public health competencies across chiropractic programs, however these have had little impact on chiropractic curricula to date. 

The workshop provided an overview of the methods and outcomes of a recent collaborative consensus project that identified sixteen core public health competencies in four domains for chiropractic programs. Workshop participants interactively engaged in assessment of the relevance and prioritization of those competencies in the context of the ongoing pandemic. Additionally, participants explored the creation of public health learning objectives for their own programs. Through engagement in the workshop, participants gained 1. Awareness of the relevance of public health competencies for the chiropractic profession; 2. Fluency in articulating public health competencies germane to chiropractic practitioners; and 3. Ability to develop public health learning objectives for their own programs.

A complex legacy of racism in the United States continues to create health inequities among people of color. Systemic biases in education, employment, housing, healthcare, access to food, accumulation of wealth, and the legal system contribute to poorer health among communities of color. These social determinants of health are driving factors behind the “weathering hypothesis”, where chronic exposure to discrimination and disadvantage lead to accelerated decline in health outcomes, particularly among Black individuals. Black Americans experience greater rates of disease in nearly every major indicator of physical health as compared to other racial and ethnic groups in the United States. Infant mortality among African Americans is twice the national average, and the life expectancy for Black men and women is consistently shorter than their White counterparts.  While this report focuses primarily on Black communities and other persons of color, we acknowledge many groups similarly face discrimination based on gender identity, sexual orientation, social class, and ability.

Background: Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life. Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear. 

Methods: We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP. Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks. The primary outcome was pain severity. Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement. Linear mixed models were used to analyze outcomes. The primary analysis included longitudinal outcomes in the short (week 4–12) and long-term (week 4–52). An omnibus test assessing differences across all groups over the year was used to control for multiplicity. Secondary analyses included outcomes at each time point and responder analyses. This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. 

Results: 241 participants were randomized and 230 (95%) provided complete primary outcome data. The primary analysis showed group differences in pain over the one-year were small and not statistically significant. Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone. Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment. One-year post-treatment pain reductions diminished in all three groups. Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone. 

Conclusions: Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain but did enhance satisfaction with care.

Objective: The purpose of this cross-sectional study was to compare functional limitations and comorbidity prevalence between older adult users and nonusers of chiropractic and osteopathic (DC/DO) manipulation to inform provider training.

Methods: We conducted a secondary analysis of the 2012 National Health Interview Survey data. Adults age 65 or older who responded to the survey were included. Descriptive statistics are reported for adults who used DC/DO manipulation (vs nonusers) regarding function, comorbidities, musculoskeletal complaints, and medical services. Weighted percentages were derived using SAS and compared with χ2 tests.

Results: The DC/DO users were more often female, overweight or obese, and of white race than nonusers. More DC/DO users reported arthritis (55.3% vs 47.0%, <0.01) or asthma (15.0% vs 10.0%, P < .01) than nonusers; hypertension (61.9% vs 55.5%, P = .02) and diabetes (20.3% vs 15.7%, P = .02) were more prevalent in nonusers; and other comorbidities were comparable. The DC/DO users reported more joint pain/stiffness (55.7% vs 44.8%), chronic pain (19.8% vs 14.2%), low back pain (27.8% vs 18.4%), low back with leg pain (18.8% vs 10.6%), and neck pain (24.2% vs 13.1%) than nonusers (all P < .01). Functional limitations affected two-thirds overall, but DC/DO users reported more difficulties stooping and bending; other limitations were comparable. One in 9 reported activities of daily living or instrumental activities of daily living limitations; nonusers were more affected. Surgery was more common among DC/DO users (26.1% vs 19.3%, <0.01); emergency room visits were comparable.

Conclusion: Differences existed between older adult manipulation users and nonusers, especially surgical utilization, musculoskeletal complaints, and comorbidities; functional differences were modest. Our findings highlight areas for provider training and awareness regarding comorbidity burden and management needs in older patients who may simultaneously use manipulation and medical care for musculoskeletal complaints.