Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial

Christine M Goertz, Stacie A Salsbury, Cynthia R Long, Robert D Vining, Andrew A Andresen, Maria A Hondras, Kevin J Lyons, Lisa Z Killinger, Fredric D Wolinsky, Robert B Wallace, Christine M Goertz, Stacie A Salsbury, Cynthia R Long, Robert D Vining, Andrew A Andresen, Maria A Hondras, Kevin J Lyons, Lisa Z Killinger, Fredric D Wolinsky, Robert B Wallace

Abstract

Background: Low back pain is a debilitating condition for older adults, who may seek healthcare from multiple providers. Few studies have evaluated impacts of different healthcare delivery models on back pain outcomes in this population. The purpose of this study was to compare clinical outcomes of older adults receiving back pain treatment under 3 professional practice models that included primary medical care with or without chiropractic care.

Methods: We conducted a pilot randomized controlled trial with 131 community-dwelling, ambulatory older adults with subacute or chronic low back pain. Participants were randomly allocated to 12 weeks of individualized primary medical care (Medical Care), concurrent medical and chiropractic care (Dual Care), or medical and chiropractic care with enhanced interprofessional collaboration (Shared Care). Primary outcomes were low back pain intensity rated on the numerical rating scale and back-related disability measured with the Roland-Morris Disability Questionnaire. Secondary outcomes included clinical measures, adverse events, and patient satisfaction. Statistical analyses included mixed-effects regression models and general estimating equations.

Results: At 12 weeks, participants in all three treatment groups reported improvements in mean average low back pain intensity [Shared Care: 1.8; 95% confidence interval (CI) 1.0 to 2.6; Dual Care: 3.0; 95% CI 2.3 to 3.8; Medical Care: 2.3; 95% CI 1.5 to 3.2)] and back-related disability (Shared Care: 2.8; 95% CI 1.6 to 4.0; Dual Care: 2.5; 95% CI 1.3 to 3.7; Medical Care: 1.5; 95% CI 0.2 to 2.8). No statistically significant differences were noted between the three groups on the primary measures. Participants in both models that included chiropractic reported significantly better perceived low back pain improvement, overall health and quality of life, and greater satisfaction with healthcare services than patients who received medical care alone.

Conclusions: Professional practice models that included primary care and chiropractic care led to modest improvements in low back pain intensity and disability for older adults, with chiropractic-inclusive models resulting in better perceived improvement and patient satisfaction over the primary care model alone.

Trial registration: Clinicaltrials.gov, NCT01312233 , 4 March 2011.

Keywords: Care coordination; Integrative medicine; Low back pain; Older adults; Pain management; Randomized controlled trial.

Conflict of interest statement

Ethics approval and consent to participate

The institutional review boards at the Palmer College of Chiropractic (2011G138) and Genesis Health System (11–005) approved the study protocol. Participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

No competing interests were declared by CMG, SAS, CRL, RDV, AAA, MAH, KJL, LZK, or FDW. RBW declared he is a clinical trial monitor for Glysure, LTD, London, England.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT flow chart
Fig. 2
Fig. 2
Percent of participants reporting levels of a. Global perceived improvement of low back pain, b. Overall health, and c. Quality of life
Fig. 3
Fig. 3
Percent of participants reporting levels of satisfaction for the information received regarding the cause of low back pain (LBP) (a), prognosis of LBP (b) and activities that hasten recovery (c), concern by MDs and DCs during treatments (d), the quality of the treatment recommendations(e) and the overall care for LBP (f)

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