Abstract
BackgroundLow 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.MethodsWe 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.ResultsAt 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.ConclusionsProfessional 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 registrationClinicaltrials.gov, NCT01312233, 4 March 2011.
Highlights
Low back pain is a debilitating condition for older adults, who may seek healthcare from multiple providers
Non-participation reasons stated at any point during the eligibility determination process included medical costs, time constraints, allocation group concerns related to being enrolled into the Medical Care group, other medical conditions requiring treatment, no perceived treatment benefit, and travel
Eight participants withdrew from the study, with 3 stating allocation to Medical Care group was one of the reasons for their withdrawal, along with travel distance and an increase in work schedule; 4 persons who quit the study did so without additional contact with study personnel to ascertain their reasons
Summary
Low back pain is a debilitating condition for older adults, who may seek healthcare from multiple providers. 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. Older people are less likely to seek healthcare or receive treatment than middle-aged adults even though they experience more disability from LBP [5]. Persons with LBP often select conservative treatments over surgery, analgesics, or opioid medications, citing concerns with treatment safety, side effects, healthcare costs and clinical outcomes [11,12,13,14]. Recent studies using nationally representative samples of older Medicare patients report that chiropractic care may provide a protective effect against declines in activities of daily living [20, 21] and offer comparable functional outcomes to medical care [22]. Economic analyses show that chiropractic users incur fewer overall and spine-related medical costs compared with patients who do not use chiropractic care [13]
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