Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data

BACKGROUND: Chronic spinal pain is prevalent and long-lasting. Although provider-based nonpharmacologic therapies, such as chiropractic care, have been recommended, healthcare and coverage policies provide little guidance or evidence regarding long-term use of this care. OBJECTIVE: To determine the relationships between visit frequency and outcomes for patients using ongoing chiropractic care for chronic spinal pain. STUDY DESIGN: Observational 3-month longitudinal study. SETTING: Data collected from patients of 124 chiropractic clinics in 6 United States regions. METHODS: We examined the impact of visit frequency and patient characteristics on pain (pain 0-10 numeric rating scale) and functional outcomes (Oswestry Disability Index [ODI] for low-back pain and Neck Disability Index [NDI] for neck pain, both 0-100 scale) using hierarchical linear modeling (HLM) in a large national sample of chiropractic patients with chronic low back pain (CLBP) and/or chronic neck pain (CNP). This study was approved by the RAND Human Subjects Protection Committee and registered under ClinicalTrials.gov Identifier: NCT03162952. RESULTS: One thousand, three hundred, sixty-two patients with CLBP and 1,214 with CNP were included in a series of HLM models. Unconditional (time-only) models showed patients on average had mild pain and function, and significant, but slight improvements in these over the 3-month observation period: back and neck pain decreased by 0.40 and 0.44 points, respectively; function improved by 2.7 (ODI) and 3.0 points (NDI) (all P < 0.001). Adding chiropractic visit frequency to the models revealed that those with worse baseline pain and function used more visits, but only visits more than once per week for those with CLBP were associated with significantly better improvement. These relationships remained when other types of visits and baseline patient characteristics were included. LIMITATIONS: This is an observational study based on self-reported data from a sample representative of chiropractic patients, but not all patients with CLBP or CNP. CONCLUSIONS: This 3-month window on chiropractic patients with CLBP and/or CNP revealed that they were improving, although slowly; may have reached maximum therapeutic improvement; and are possibly successfully managing their chronic pain using a variety of chiropractic visit frequencies. These results may inform payers when building coverage policies for ongoing chiropractic care for patients with chronic pain. KEY WORDS: Chronic low back pain, chronic neck pain, spinal pain, physical function, hierarchical linear modeling, healthcare utilization, chiropractic visits, insurance coverage

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Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients

Spine ◽

10.1097/brs.0000000000004009 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ian D. Coulter ◽

Patricia M. Herman ◽

Mallika Kommareddi ◽

Eric L. Hurwitz ◽

Paul G. Shekelle

Keyword(s):

Neck Pain ◽

Spinal Manipulation ◽

Chronic Neck Pain ◽

Low Back

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Female Gender Is Associated with a Higher Prevalence of Chronic Neck Pain, Chronic Low Back Pain, and Migraine: Results of the Spanish National Health Survey, 2017

Pain Medicine ◽

10.1093/pm/pnaa368 ◽

2020 ◽

Author(s):

Domingo Palacios-Ceña ◽

Romana Albaladejo-Vicente ◽

Valentin Hernández-Barrera ◽

Lidiane Lima-Florencio ◽

Cesar Fernández-de-las-Peñas ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Neck Pain ◽

National Health ◽

Health Survey ◽

Chronic Low Back Pain ◽

Chronic Neck Pain ◽

National Health Survey ◽

Low Back ◽

Care Providers

Abstract Objectives To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine headache (MH) in the Spanish population and to identify sociodemographic and health-related variables associated with CNP, CLBP, and MH. Design Observational study. Setting Spain. Subjects A total of 22,511 persons 18 years of age or older (10,304 males and 12,207 females) who participated in the 2017 Spanish National Health Survey. Methods Stratified three-stage sampling was applied. CNP, CLBP, and MH were the dependent variables. The analysis was conducted separately by gender. Sociodemographic features, self-perceived health status, lifestyle habits, comorbidities, and pain features were analyzed by using logistic regression models. Results Females reported a higher prevalence of CNP, CLBP, and MH (P < 0.001) than males. For both sexes, anxiety and/or depression and poor self-rated health were associated with a significantly increased prevalence of CNP, CLBP, and MH. For CNP and CLBP, the identified associated factors were older age and limitations to usual activity. For CNP and MH, the most common associated factor was comorbid respiratory disease. Conclusions Our study identified several factors associated with CNP, CLBP, and MH in Spanish female and male adults, with potential implications for health care providers.

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Improvement After Chiropractic Care in Cervicocephalic Kinesthetic Sensibility and Subjective Pain Intensity in Patients with Nontraumatic Chronic Neck Pain

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2005.12.002 ◽

2006 ◽

Vol 29 (2) ◽

pp. 100-106 ◽

Cited By ~ 67

Author(s):

Per J. Palmgren ◽

Peter J. Sandström ◽

Fredrik J. Lundqvist ◽

Hannu Heikkilä

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Chronic Neck Pain ◽

Chiropractic Care ◽

Subjective Pain

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Experiences With Chiropractic Care for Patients With Low Back or Neck Pain

Journal of Patient Experience ◽

10.1177/2374373519846022 ◽

2019 ◽

Vol 7 (3) ◽

pp. 357-364 ◽

Cited By ~ 1

Author(s):

Ron D Hays ◽

Cathy D Sherbourne ◽

Karen L Spritzer ◽

Lara G Hilton ◽

Gery W Ryan ◽

...

Keyword(s):

Neck Pain ◽

Healthcare Providers ◽

The United States ◽

Chiropractic Care ◽

National Database ◽

Low Back ◽

Online Questionnaire ◽

Percentage Points ◽

Appointment Time ◽

Consumer Assessment

Background: Musculoskeletal disorders are the second leading cause of disability worldwide. Objective: Examine experiences of chiropractic patients in the United States with chronic low back or neck pain. Method: Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care. Results: We found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points). Conclusions: The positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care.

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Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: A latent class growth analysis

European Journal of Pain ◽

10.1002/ejp.1094 ◽

2017 ◽

Vol 22 (1) ◽

pp. 103-113 ◽

Cited By ~ 7

Author(s):

L. Ailliet ◽

S.M. Rubinstein ◽

T. Hoekstra ◽

M.W. van Tulder ◽

H.C.W. de Vet

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Neck Pain ◽

Growth Analysis ◽

Latent Class ◽

Chiropractic Care ◽

Low Back ◽

Latent Class Growth Analysis ◽

Latent Class Growth

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Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials

Trials ◽

10.1186/1745-6215-15-490 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 26

Author(s):

Susanne Blödt ◽

Daniel Pach ◽

Stephanie Roll ◽

Claudia M Witt

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Neck Pain ◽

Study Protocol ◽

Chronic Low Back Pain ◽

Chronic Neck Pain ◽

Low Back ◽

Pragmatic Trials

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Gender Differences in the Prevalence and Characteristics of Pain in Spain: Report from a Population-Based Study

Pain Medicine ◽

10.1093/pm/pnz004 ◽

2019 ◽

Vol 20 (12) ◽

pp. 2349-2359 ◽

Cited By ~ 6

Author(s):

Isabel Jiménez-Trujillo ◽

Ana López-de-Andrés ◽

José Luis del Barrio ◽

Valentín Hernández-Barrera ◽

Marisa Valero-de-Bernabé ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Neck Pain ◽

Chronic Low Back Pain ◽

Female Gender ◽

Chronic Neck Pain ◽

Population Based ◽

Low Back ◽

Cross Sectional ◽

Self Rated Health

Abstract Objective To assess the prevalence and characteristics of chronic neck pain, chronic low back pain, and migraine or frequent headaches among Spanish adults in 2014 according to gender, to identify predictors for each of these types of pains, and to compare the prevalence with those found in 2009. Design Cross-sectional study. Setting Spain. Methods We used data collected from the 2014 European Health Interview Survey (N = 22,842). Sociodemographic features, self-rated health status, lifestyle habits, comorbid conditions, pain characteristics, and self-reported use of medications were analyzed. Results The prevalence of all types of pain was significantly higher among women than men. For chronic neck pain, the figures were 25.68% vs 12.54%, for chronic low back pain, 27.03% vs 18.83%, and for migraine or frequent headaches, 15.93% vs 6.74%, in women and men, respectively. Predictors of these types of pain included female gender, advanced age, poor self-rated health, psychological distress, comorbidities, and obesity. The prevalence of neck pain and low back pain increased from 2009 to 2014 for both sexes, and the prevalence of migraine or frequent headaches remained stable over time. Conclusions The prevalence and intensity of all the forms of chronic pain were higher among women. Women experiencing pain used prescribed medications for pain, anxiety, and/or depression and sleeping pills more than men. The prevalence of chronic neck and low back has increased in the last five years in Spain, and the prevalence of migraine or frequent headaches has remained stable.

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