Article

Health equity is the principle of ensuring that all individuals have optimal opportunities to attain the best health possible, addressing disparities in access, outcomes, costs, quality, and appropriateness of care. This focus on health equity is important in healthcare research, driven by the need to investigate systemic injustices and foster fair health outcomes for all, regardless of background or circumstances. Researchers have an ethical imperative to focus on issues relevant to populations bearing the highest burdens of illness and inequities. To address the gap in structured guidance for incorporating health equity principles in health-related research, this study aims to introduce a comprehensive health equity checklist developed by the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center. The checklist is designed to ensure that every stage of the research process integrates health equity considerations. RAND, in collaboration with complementary and integrative health academic institutions across the United States, Canada and Puerto Rico, developed a health equity checklist. They combed through literature to assess existing guidance and developed the checklist based on gaps in literature and the specific needs identified through consultations with community partners and stakeholders. This checklist emphasizes creating a health equity research culture, involving community partners, designing inclusive research/interventions, securing equitable funding, and engaging diverse participants. It also advocates for equitable intervention delivery, data collection, analysis, and effective dissemination and sustainability of research findings. The health equity checklist provides a practical guide for researchers, community partners, and participants to reflect on inclusivity, cultural relevance, and social justice in health research. By implementing this checklist, researchers can ensure that their studies are both inclusive and impactful in advancing health equity across all areas of health-related research. Achieving health equity in research requires a comprehensive approach and significant investment in building sustainable partnerships. The RAND REACH Center's recommendations provide a guide to ensure research advances scientific understanding while actively contributing to health equity. This paradigm shift necessitates support from funding agencies and a long-term commitment to creating equitable health outcomes.

Objective: 
Collaboration between complementary and integrative health (CIH) institutions and research-intensive (R1) institutions has been successfully undertaken in the United States, resulting in federally funded research projects, educational programs, and faculty development. The aim of this cross-sectional survey study was to explore the barriers and facilitators to establishing and maintaining such collaborative partnerships.

Methods: A 32-question survey was sent to participants recruited through author contacts and resources, literature review, and database searches. Participants were required to be researchers and affiliates who attempted, completed, or had current collaborative endeavors involving CIH and R1 institutions. Data were collected in the research electronic data capture (REDCap) system and descriptive quantitative and qualitative data analysis was undertaken.

Results: A total of 26 unique entries were included in the final data analysis; four of which were paired entries (one from an R1 institution and one from a CIH institution) to make up two dyad data collections. Eighty-one percent of the participants had senior leadership roles at CIH institutions representing five CIH disciplines—East Asian medicine (acupuncture and Traditional Chinese Medicine), chiropractic medicine, massage therapy, naturopathy, and yoga. Collaborative research projects were often (>38%) in response to specific project funding mechanisms. Over 60% of the collaborations also included educational activities and faculty development. Collaborations resulted in multiple different types of benefits to both institutions but were not without associated challenges.

Conclusion: Collaborations between R1 and CIH institutions can be cooperative, productive, and mutually beneficial. Funding mechanisms supporting R1 and CIH collaboration increase CIH research productivity as well as the development of innovative research methodology to study the real-world practice of CIH therapies, whole systems, and whole person health. CIH researchers would greatly benefit from such funding, allowing access to research infrastructure, professional development, and the provision of protected time to conduct research.

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.

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS).

Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8–13 MHz) over L5/S1 facets; long-axis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors’ assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared.

Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt step-off defect at L5PI.

Conclusion: We report the first technique description and verification of the L5PI using DUS.

Background: Patient perceptions may influence the effectiveness and utilization of healthcare interventions, particularly for complex health conditions such as sciatica or back-related leg pain (BRLP).

Objectives: To explore BRLP patients' perceptions of spinal manipulative therapy (SMT) and home exercise with advice (HEA).

Design: Qualitative study in a controlled clinical trial.

Method: Semi-structured interviews conducted after 12 weeks of treatment asked participants about
satisfaction with care and whether treatment was worthwhile. An interdisciplinary research team
conducted content analysis using qualitative data analysis software to identify and summarize themes.

Results: Of 192 trial participants, 174 (91%) completed interviews (66% female, age 57.0 ± 11.5 years).
Participants identified interactions with providers and staff, perceived treatment effects, and information
as key contributors to both their satisfaction and the worthwhile nature of treatment. HEA was liked for
its convenience and ability to foster an exercise habit. SMT was liked for specific aspects of the modality
(e.g. manipulation, stretching) and provider competency. Most participants reported no dislikes for SMT
or HEA, but some noted the dose/time commitment for SMT and discipline of HEA as least liked aspects
of the interventions.

Conclusions: The quality of patient-provider interactions, perceived treatment effects, and information
sharing influenced BRLP patients' satisfaction with care. Qualitative research describing patients' preferences can facilitate translation of study findings into practice and allow clinicians to tailor treatments
to facilitate compliance and satisfaction with care.

The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women’s, children’s, and adolescents’ health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve. 

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.

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.

Health care at the interface of medical and mental health in the United States is problematic.  The goals of mental and behavioral health service integration into primary care settings are to reduce the fragmentation and inadequate care of mental health problems in primary care patients and to improve the care of medical issues complicated by mental health problems.