Swiss chiropractic practice-based research network and musculoskeletal pain cohort pilot study: protocol of a nationwide resource to advance musculoskeletal health services research

Rahim Lalji, Léonie Hofstetter, Alice Kongsted, Viktor von Wyl, Milo A Puhan, Cesar A Hincapié, Rahim Lalji, Léonie Hofstetter, Alice Kongsted, Viktor von Wyl, Milo A Puhan, Cesar A Hincapié

Abstract

Introduction: Musculoskeletal (MSK) pain conditions, a leading cause of global disability, are usually first managed in primary care settings such as medical, physiotherapy, and chiropractic community-based practices. While chiropractors often treat MSK conditions, there is limited real-world evidence on the topic of health service outcomes among patients receiving this type of care. A nationwide Swiss chiropractic practice-based research network (PBRN) and MSK pain patient cohort study will have potential to monitor the epidemiological trends of MSK pain conditions and contribute to healthcare quality improvement. The primary aims of this protocol are to (1) describe the development of an MSK-focused PBRN within the Swiss chiropractic setting, and (2) describe the methodology of the first nested study to be conducted within the PBRN-an observational prospective patient cohort pilot study.

Methods and analysis: This initiative is conceptualised with two distinct phases. Phase I focuses on the development of the Swiss chiropractic PBRN, and will use a cross-sectional design to collect information from chiropractic clinicians nationwide. Phase II will recruit consecutive patients aged 18 years or older with MSK pain from community-based chiropractic practices participating in the PBRN into a prospective chiropractic cohort pilot study. All data collection will occur through electronic surveys offered in the three Swiss official languages (German, French, Italian) and English. Surveys will be provided to patients prior to their initial consultation in clinics, 1 hour after initial consultation, and at 2, 6 and 12 weeks after initial consultation.

Ethics and dissemination: Ethics approval has been obtained from the independent research ethics committee of Canton Zurich (BASEC-Nr: 2021-01479). Informed consent will be obtained electronically from all participants. Findings will be reported to stakeholders after each study phase, presented at local and international conferences, and disseminated through peer-reviewed publications.

Study pre-registration: Phase I-Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Phase 2-Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).

Keywords: epidemiology; musculoskeletal disorders; primary care; quality in health care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Nested design of the Swiss chiropractic practice-based research network (PBRN) and the Swiss ChiCo pilot study.
Figure 2
Figure 2
Summary of the Swiss ChiCo pilot study in-clinic patient participant recruitment. PBRN, practice-based research network.

References

    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017;390:1211–59. 10.1016/S0140-6736(17)32154-2
    1. Murray CJL, Vos T, Lozano R, et al. . Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2197–223. 10.1016/S0140-6736(12)61689-4
    1. Wieser S, Horisberger B, Schmidhauser S, et al. . Cost of low back pain in Switzerland in 2005. Eur J Health Econ 2011;12:455–67. 10.1007/s10198-010-0258-y
    1. Qaseem A, Wilt TJ, McLean RM, et al. . Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166:514. 10.7326/M16-2367
    1. Kreiner DS, Matz P, Bono CM, et al. . Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J 2020;20:998–1024. 10.1016/j.spinee.2020.04.006
    1. Bussières AE, Stewart G, Al-Zoubi F, et al. . Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther 2018;41:265–93. 10.1016/j.jmpt.2017.12.004
    1. Bussières AE, Stewart G, Al-Zoubi F, et al. . The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther 2016;39:523–64. 10.1016/j.jmpt.2016.08.007
    1. Hartvigsen J, Davidsen M, Hestbaek L, et al. . Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain 2013;17:452–60. 10.1002/j.1532-2149.2012.00225.x
    1. Kamaleri Y, Natvig B, Ihlebaek CM, et al. . Localized or widespread musculoskeletal pain: does it matter? Pain 2008;138:41–6. 10.1016/j.pain.2007.11.002
    1. Hincapié CA, Cassidy JD, Côté P, et al. . Whiplash injury is more than neck pain: a population-based study of pain localization after traffic injury. J Occup Environ Med 2010;52:434–40. 10.1097/JOM.0b013e3181bb806d
    1. Babatunde OO, Jordan JL, Van der Windt DA, et al. . Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS One 2017;12:e0178621. 10.1371/journal.pone.0178621
    1. Artus M, Campbell P, Mallen CD, et al. . Generic prognostic factors for musculoskeletal pain in primary care: a systematic review. BMJ Open 2017;7:e012901. 10.1136/bmjopen-2016-012901
    1. Westfall JM, Mold J, Fagnan L. Practice-based research—“blue highways” on the NIH roadmap. JAMA 2007;297:403. 10.1001/jama.297.4.403
    1. Adams J, Steel A, Moore C, et al. . Establishing the ACORN national practitioner database: strategies to recruit practitioners to a national practice-based research network. J Manipulative Physiol Ther 2016;39:594–602. 10.1016/j.jmpt.2016.08.006
    1. Kongsted A, Davies L, Axen I. Low back pain patients in Sweden, Denmark and the UK share similar characteristics and outcomes: a cross-national comparison of prospective cohort studies. BMC Musculoskelet Disord 2015;16:367. 10.1186/s12891-015-0824-7
    1. Hestbaek L, Munck A, Hartvigsen L, et al. . Low back pain in primary care: a description of 1250 patients with low back pain in Danish general and chiropractic practice. Int J Family Med 2014;2014:10610210.1155/2014/106102
    1. Agency for Healthcare Research and Quality, Rockville, MD . Primary care practice-based research networks, 2018. Available: [Accessed 20 Sep 2021].
    1. Pearce KA, Love MM, Barron MA, et al. . How and why to study the practice content of a practice-based research network. Ann Fam Med 2004;2:425–8. 10.1370/afm.133
    1. Humphreys BK, Peterson CK, Muehlemann D, et al. . Are Swiss chiropractors different than other chiropractors? Results of the job analysis survey 2009. J Manipulative Physiol Ther 2010;33:519–35. 10.1016/j.jmpt.2010.08.003
    1. Lin I, Wiles L, Waller R, et al. . What does best practice care for musculoskeletal pain look like? eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020;54:79–86. 10.1136/bjsports-2018-099878
    1. Adams J, Peng W, Steel A, et al. . A cross-sectional examination of the profile of chiropractors recruited to the Australian Chiropractic Research Network (ACORN): a sustainable resource for future chiropractic research. BMJ Open 2017;7:e015830. 10.1136/bmjopen-2017-015830
    1. Adams J, Steel A, Chang S, et al. . Helping address the National research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project. Chiropr Man Therap 2015;23:12. 10.1186/s12998-015-0057-8
    1. Lang DJ, Wiek A, Bergmann M, et al. . Transdisciplinary research in sustainability science: practice, principles, and challenges. Sustain Sci 2012;7:25–43. 10.1007/s11625-011-0149-x
    1. Steel A, Peng W, Sibbritt D, et al. . Introducing national osteopathy practice-based research networks in Australia and New Zealand: an overview to inform future osteopathic research. Sci Rep 2020;10:846. 10.1038/s41598-020-57918-7
    1. Patridge EF, Bardyn TP. Research electronic data capture (REDCap). Jmla 2018;106:142–4. 10.5195/jmla.2018.319
    1. Smucker DR, Konrad TR, Curtis P, et al. . Practitioner self-confidence and patient outcomes in acute low back pain. Arch Fam Med 1998;7:223–8. 10.1001/archfami.7.3.223
    1. Duncan K. The development and testing of a generic musculoskeletal version of the pain attitudes and beliefs scale [Doctoral thesis], 2017. Available: [Accessed 11 Oct 2021].
    1. Krebs EE, Lorenz KA, Bair MJ, et al. . Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med 2009;24:733–8. 10.1007/s11606-009-0981-1
    1. Hill JC, Kang S, Benedetto E, et al. . Development and initial cohort validation of the arthritis research UK musculoskeletal health questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open 2016;6:e012331. 10.1136/bmjopen-2016-012331
    1. Broadbent E, Petrie KJ, Main J, et al. . The brief illness perception questionnaire. J Psychosom Res 2006;60:631–7. 10.1016/j.jpsychores.2005.10.020
    1. Kongsted A, Nielsen OL, Christensen HW, et al. . The Danish chiropractic low back pain cohort (ChiCo): description and summary of an available data source for research collaborations. Clin Epidemiol 2020;12:1015–27. 10.2147/CLEP.S266220
    1. Glattacker M, Bengel J, Jäckel WH. Die deutschsprachige version des illness perception questionnaire-revised: psychometrische evaluation an patienten MIT chronisch somatischen erkrankungen. Zeitschrift für Gesundheitspsychologie 2009;17:158–69.
    1. Giardini A, Majani G, Pierobon A. Contributo alla validazione italiana dell’IPQ-R. G Ital Med Lav Erg 2007;29.
    1. Broadbent E, Wilkes C, Koschwanez H, et al. . A systematic review and meta-analysis of the brief illness perception questionnaire. Psychol Health 2015;30:1361–85. 10.1080/08870446.2015.1070851
    1. Karstens S, Christiansen DH, Brinkmann M. German translation, cross-cultural adaptation and validation of the musculoskeletal health questionnaire: a cohort study. Eur J Phys Rehabil Med 2021;56:771–9. 10.23736/S1973-9087.20.06054-2
    1. Galeoto G, Piepoli V, Ciccone E. Musculoskeletal health questionnaire: translation, cultural adaptation and validation of the Italian version (MSK-HQ-I). Muscle Ligaments Tendons J 2019;09:295–303. 10.32098/mltj.02.2019.20
    1. Schmidt CO, Kohlmann T, Pfingsten M, et al. . Construct and predictive validity of the German Örebro questionnaire short form for psychosocial risk factor screening of patients with low back pain. Eur Spine J 2016;25:325–32. 10.1007/s00586-015-4196-3
    1. Hilfiker R, Knutti IA, Raval-Roland B, et al. . Validity and responsiveness of the French version of the Örebro musculoskeletal pain screening questionnaire in chronic low back pain. Eur Spine J 2016;25:2741–9. 10.1007/s00586-016-4635-9
    1. Oxford University Innovation . Health outcomes - Musculoskeletal Health Questionnaire (MSK-HQ). Available: [Accessed 16 Jul 2021].
    1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011;104:510–20. 10.1258/jrsm.2011.110180
    1. Steinemann N, Kuhle J, Calabrese P, et al. . The Swiss multiple sclerosis registry (SMSR): study protocol of a participatory, nationwide registry to promote epidemiological and patient-centered MS research. BMC Neurol 2018;18:111. 10.1186/s12883-018-1118-0
    1. Puhan MA, Steinemann N, Kamm CP, et al. . A digitally facilitated citizen-science driven approach accelerates participant recruitment and increases study population diversity. Swiss Med Wkly 2018;148:w14623. 10.4414/smw.2018.14623
    1. Hincapié CA, Hofstetter L, Lalji R, et al. . Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study. J Med Internet Res 2022. 10.2196/40501
    1. Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Örebro musculoskeletal pain screening questionnaire. Spine 2011;36:1891–5. 10.1097/BRS.0b013e3181f8f775
    1. Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther 2009;17:163–70. 10.1179/jmt.2009.17.3.163

Source: PubMed

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