143. Chiropractors treating patients with acute lower back pain in a spine treatment pathway model: a five-year prospective cohort study

Abstract

BACKGROUND CONTEXT Patient access to current best evidence primary care treatment for acute lower back remains highly problematic. Treatment pathway models have the potential to improve patient access to care, provide seamless transitions from one form of treatment to another, optimize clinical outcomes, improve cost-effectiveness and reduce progression to chronic illness /pain. A standardized protocol of hospital-based outpatient clinic chiropractic lumbar spinal manipulative therapy (CSMT) as a component of care for patients with acute lower back pain (ALBP) has been previously validated. PURPOSE To determine the feasibility and patient satisfaction of a community-based standardized chiropractic treatment protocol as a component of a primary care spine treatment pathway in the treatment of patients with ALBP. STUDY DESIGN/SETTING Feasibility prospective cohort study. PATIENT SAMPLE Inclusion: Patients with ALBP without radiculopathy of less than 24 weeks; Exclusion: Red flag conditions; SPECT scan positive facet arthropathy; > Grade IV Thompson lumbar disc degeneration at one or more levels; relevant DSM 5 diagnoses; third-party insurer involvement. OUTCOME MEASURES Willingness to participate of ALBP patients and community chiropractors. Rate of compliance with a standardized treatment protocol in community-based chiropractors. Patient wait times, satisfaction scores, pre- and post-VAS and ODI scores, need for additional imaging, rate of discharge from hospital outpatient clinic. METHODS Community-based chiropractors from three British Columbia Provincial Health Regions agreed to accept referrals from a hospital-supervised primary care spine program to treat ALBP patients with a standardized protocol comprised of a maximum four-week course of lumbar spine CSMT only and a lumbar spine flexibility instruction exercise program. Participating patients were seen for follow-up in the hospital spine outpatient clinic at four and eight weeks post-treatment. RESULTS Over the five-year duration of the study, 368/380 (97%) of eligible patients and 21/26 (81%) of community-based chiropractors agreed to participate. Seventeen of 21 chiropractors (81%) consistently administered treatment within the boundaries of the standardized research study protocol. VAS and ODI scores improved significantly in 320/368 (87%) patients. The average wait time for access to treatment was 7.4 days. Eighty-two percent of patients reported high satisfaction scores. The rate of required additional diagnostic imaging was 3%. Rates of discharge from the hospital spine program outpatient clinic with no requested follow-up by six months was 86%. CONCLUSIONS A standardized protocol of CSMT and flexibility exercise instruction administered by community-based chiropractors to a specific cohort of patients with ALBP is a feasible component of a primary care spine treatment pathway. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.