scholarly journals Veteran Response to Dosage in Chiropractic Therapy (VERDICT): Study Protocol of a Pragmatic Randomized Trial for Chronic Low Back Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_2) ◽  
pp. S37-S44
Author(s):  
Cynthia R Long ◽  
Anthony J Lisi ◽  
Robert D Vining ◽  
Robert B Wallace ◽  
Stacie A Salsbury ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Phase 1 ◽  
Chiropractic Care ◽  
Veterans Affairs ◽  
Health Care Facilities ◽  
Low Back ◽  
Phase 2 ◽  
Care Facilities

Conflicts of interest: No potential conflicts exist for any author listed.Abstract Background Low back pain is a leading cause of disability in veterans. Chiropractic care is a well-integrated, nonpharmacological therapy in Veterans Affairs health care facilities, where doctors of chiropractic provide therapeutic interventions focused on the management of low back pain and other musculoskeletal conditions. However, important knowledge gaps remain regarding the effectiveness of chiropractic care in terms of the number and frequency of treatment visits needed for optimal outcomes in veterans with low back pain. Design This pragmatic, parallel-group randomized trial at four Veterans Affairs sites will include 766 veterans with chronic low back pain who are randomly allocated to a course of low-dose (one to five visits) or higher-dose (eight to 12 visits) chiropractic care for 10 weeks (Phase 1). After Phase 1, participants within each treatment arm will again be randomly allocated to receive either monthly chiropractic chronic pain management for 10 months or no scheduled chiropractic visits (Phase 2). Assessments will be collected electronically. The Roland Morris Disability Questionnaire will be the primary outcome for Phase 1 at week 10 and Phase 2 at week 52. Summary This trial will provide evidence to guide the chiropractic dose in an initial course of care and an extended-care approach for veterans with chronic low back pain. Accurate information on the effectiveness of different dosing regimens of chiropractic care can greatly assist health care facilities, including Veterans Affairs, in modeling the number of doctors of chiropractic that will best meet the needs of patients with chronic low back pain.

scholarly journals Efficacy of Bioelectrical Impedance Analysis for the Evaluation of Physical Impairment in Chronic Low Back Pain. Results from a Cohort Study

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 919-927
Author(s):  
Dimitrios Kechagias ◽  
Christos Chatzipapas ◽  
Makrina Karaglani ◽  
Konstantinos Tilkeridis ◽  
Athanasios Ververidis ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Condition ◽  
Chronic Low Back Pain ◽  
Structural Changes ◽  
Phase 1 ◽  
Low Back ◽  
Bioimpedance Analysis ◽  
Locomotor System ◽  
General Physical

Introduction: Determining the effect of body composition on chronic low back pain seems to have the potential to improve our understanding of its mechanism and to develop novel preventive and therapeutic approaches.  Aim: The purpose of the present study was to assess by electrical impedance the composition of lower extremities of individuals with chronic low back pain. Materials and methods: One hundred and twenty-one adult participants with diagnosed chronic low back pain were recruited in this study. The study activities were divided into three phases: phase 1 – self-administered questionnaires, phase 2 – biomedical examination (including anthropometric measurements and physical function performance tests), and phase 3 – bioimpedance analysis. Results: Our results showed that chronic low back pain differentiates the circumference of thigh and calf of the symptomatic leg. Besides, patients experience pain also in hip, thigh, and calf, which act as a barrier to patient’s personal, professional, social, and recreational activities. Furthermore, patients appear with ‘unstable’ walking, reduced balance, and reduced general physical condition that affect all of the neuromuscular structures of the locomotor system. Interestingly, patients seem to be characterized by a tendency to deposit fat and to decrease muscle mass in the symptomatic limb regardless of the gender. Conclusions: In the present study, we determine the profile of a patient with chronic low back pain through a variety of measurements. Chronic low back pain causes several structural changes to the symptomatic leg of the patients leading to ‘unstable’ walking, reduced balance, and reduced general physical condition. It is clear that further studies using bioimpedance analysis are needed to address the concerns raised by investigating a multifactorial condition such as chronic low back pain.

Dose-response for chiropractic care of chronic low back pain

2004 ◽  
Vol 4 (5) ◽  
pp. 574-583 ◽  
Author(s):  
Mitchell Haas ◽  
Elyse Groupp ◽  
Dale F. Kraemer
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Dose Response ◽  
Chronic Low Back Pain ◽  
Chiropractic Care ◽  
Low Back

scholarly journals Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study

2015 ◽  
Vol 95 (8) ◽  
pp. 1120-1134 ◽  
Author(s):  
Jason M. Beneciuk ◽  
Steven Z. George
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Phase 1 ◽  
Attitudes And Beliefs ◽  
Low Back ◽  
Phase 2 ◽  
Stratified Care ◽  
Care Training ◽  
Preliminary Study

Background The effectiveness of risk stratification for low back pain (LBP) management has not been demonstrated in outpatient physical therapy settings. Objective The purposes of this study were: (1) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and (2) to determine feasibility of conducting a larger-scale study. Design This was a 2-phase, preliminary study. Methods In phase 1, clinicians were randomly assigned to receive standard (n=6) or stratified care (n=6) training. Stratified care training included 8 hours of content focusing on psychologically informed practice. Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). In phase 2, clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale (NPRS), and the Oswestry Disability Index (ODI). Study feasibility was assessed to identify potential barriers for completion of a larger-scale study. Results In phase 1, minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians (Cohen d=0.00–0.28). Decreased biomedical (−4.5±2.5 points, d=1.08) and increased biopsychosocial (+5.5±2.0 points, d=2.86) treatment orientations were observed for stratified care clinicians, with these changes sustained 6 months later on the PABS-PT. In phase 2, patients receiving stratified care (n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1, 13.6; d=0.76) scores compared with patients receiving standard physical therapy care (n=33). Limitations In phase 2, treatment was not randomly assigned, and therapist adherence to treatment recommendations was not monitored. This study was not adequately powered to conduct subgroup analyses. Conclusions In physical therapy settings, biomedical orientation can be modified, and risk-stratified care for LBP can be effectively implemented. Findings from this study can be used for planning of larger studies.

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