Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

Overview

Journal J Manipulative Physiol Ther

Date 2019 Dec 23

PMID 31864769

Citations 11

Authors

Robert D Vining

Zacariah K Shannon

Stacie A Salsbury

Lance Corber

Amy L Minkalis

Christine M Goertz

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities.

Methods: A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range.

Results: Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool.

Conclusion: This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.

Citing Articles

Addressing the "Black Hole" of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study.

Rudin R, Herman P, Vining R JMIR Form Res. 2025; 9:e66666.

PMID: 39903908 PMC: 11813196. DOI: 10.2196/66666.

Secondary causal mediation analysis of a pragmatic clinical trial to evaluate the effect of chiropractic care for US active-duty military on biopsychosocial outcomes occurring through effects on low back pain interference and intensity.

Shannon Z, Long C, Chrischilles E, Goertz C, Wallace R, Casteel C BMJ Open. 2024; 14(11):e083509.

PMID: 39566948 PMC: 11580239. DOI: 10.1136/bmjopen-2023-083509.

Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors.

Shannon Z, Long C, Chrischilles E, Goertz C, Wallace R, Casteel C PLoS One. 2024; 19(10):e0310642.

PMID: 39352877 PMC: 11444394. DOI: 10.1371/journal.pone.0310642.

Intervention Fidelity in Pain Pragmatic Trials for Nonpharmacologic Pain Management: Nuanced Considerations for Determining PRECIS-2 Flexibility in Delivery and Adherence.

Kerns R, Davis A, Fritz J, Keefe F, Peduzzi P, Rhon D J Pain. 2022; 24(4):568-574.

PMID: 36574858 PMC: 10079571. DOI: 10.1016/j.jpain.2022.12.008.

Comprehensive evaluation of military training-induced fatigue among soldiers in China: A Delphi consensus study.

Ruan Y, Song S, Yin Z, Wang M, Huang N, Gu W Front Public Health. 2022; 10:1004910.

PMID: 36523578 PMC: 9745162. DOI: 10.3389/fpubh.2022.1004910.

References

Hawk C, Schneider M, Dougherty P, Gleberzon B, Killinger L . Best practices recommendations for chiropractic care for older adults: results of a consensus process. J Manipulative Physiol Ther. 2010; 33(6):464-73. DOI: 10.1016/j.jmpt.2010.06.010. View

Engell S, Triano J, Fox J, Langevin H, Konofagou E . Differential displacement of soft tissue layers from manual therapy loading. Clin Biomech (Bristol). 2016; 33:66-72. DOI: 10.1016/j.clinbiomech.2016.02.011. View

Neto T, Freitas S, Marques M, Gomes L, Andrade R, Oliveira R . Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2017; 27:14-22. DOI: 10.1016/j.msksp.2016.11.014. View

Bialosky J, Bishop M, Price D, Robinson M, George S . The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2008; 14(5):531-8. PMC: 2775050. DOI: 10.1016/j.math.2008.09.001. View

Ellis R, Hing W . Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther. 2009; 16(1):8-22. PMC: 2565076. DOI: 10.1179/106698108790818594. View

Bussieres A, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Haskett D . 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(4):265-293. DOI: 10.1016/j.jmpt.2017.12.004. View

Richmond H, Hall A, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N . The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10(8):e0134192. PMC: 4526658. DOI: 10.1371/journal.pone.0134192. View

Haldeman S, Johnson C, Chou R, Nordin M, Cote P, Hurwitz E . The Global Spine Care Initiative: classification system for spine-related concerns. Eur Spine J. 2018; 27(Suppl 6):889-900. DOI: 10.1007/s00586-018-5724-8. View

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

10.

Nijs J, Apeldoorn A, Hallegraeff H, Clark J, Smeets R, Malfliet A . Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician. 2015; 18(3):E333-46. View

11.

Joseph M, Taft K, Moskwa M, Denegar C . Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. J Sport Rehabil. 2012; 21(4):343-53. DOI: 10.1123/jsr.21.4.343. View

12.

DeWalt D, Berkman N, Sheridan S, Lohr K, Pignone M . Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004; 19(12):1228-39. PMC: 1492599. DOI: 10.1111/j.1525-1497.2004.40153.x. View

13.

Murphy D, Hurwitz E, McGovern E . A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. J Manipulative Physiol Ther. 2009; 32(9):723-33. DOI: 10.1016/j.jmpt.2009.10.007. View

14.

May S, Aina A . Centralization and directional preference: a systematic review. Man Ther. 2012; 17(6):497-506. DOI: 10.1016/j.math.2012.05.003. View

15.

Langevin H, Sherman K . Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med Hypotheses. 2006; 68(1):74-80. DOI: 10.1016/j.mehy.2006.06.033. View

16.

Hadler N, Curtis P, Gillings D, Stinnett S . A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial. Spine (Phila Pa 1976). 1987; 12(7):702-6. View

17.

Petersen T, Laslett M, Juhl C . Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord. 2017; 18(1):188. PMC: 5429540. DOI: 10.1186/s12891-017-1549-6. View

18.

Snelgrove S, Liossi C . Living with chronic low back pain: a metasynthesis of qualitative research. Chronic Illn. 2013; 9(4):283-301. DOI: 10.1177/1742395313476901. View

19.

Bennett R . Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007; 21(3):427-45. DOI: 10.1016/j.berh.2007.02.014. View

20.

Vining R, Potocki E, Seidman M, Morgenthal A . An evidence-based diagnostic classification system for low back pain. J Can Chiropr Assoc. 2013; 57(3):189-204. PMC: 3743645. View