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| ID | Type | Description | Link |
|---|---|---|---|
| K23AT010487 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Center for Complementary and Integrative Health (NCCIH) | NIH |
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The goal of this study is to evaluate the feasibility of new implementation strategies designed to increase the number of Primary Care Providers (PCPs) referrals to chiropractic care for lower back pain (LBP) in underserved populations. The investigators plan to pilot the strategies in three qualified community health centers (CHCs) and compare the number of LBP patients who receive referrals before and after implementation. The implementation strategies involve PCP, patient, and organizational interventions.
Patients presenting with LBP will be provided educational materials that focus on the safety and effectiveness of chiropractic care as an evidence-based treatment for LBP. Materials will be available in CHC common areas and may be sent to patients by their PCP via patient portal.
PCPs will participate in interactive lunch seminars to allow for inter-professional learning for PCPs. They will also participate in a survey regarding their attitudes and beliefs relating to chiropractic care. Currently, many PCPs cannot make chiropractic care referrals in the electronic health record (EHR). The investigators plan to add this option, or make it easier if the referral is already available.
This multi-level, multi-component approach will last two months, and will be rolled out sequentially in three clinics using a stepped-wedge design. The ordering of clinics will be random.
The primary outcome is the proportion of patients with LBP who received a referral to chiropractic care before and after the intervention. Secondary outcomes include referral to any non-pharmacologic treatment, use of imaging, and prescribed medications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Implementation | Experimental | Implementation will be deployed at the CHC, PCP, and patient level. |
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| Standard of care | No Intervention | Usual patient care without deployment of intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Institutional interventions | Other | Intervention will include, but not be limited to, the following: adding a referral option to chiropractic care in the electronic health record (EHR), optimizing referral option, e.g., creating a list of preferred providers. Additional strategies may be added depending on community health center staff engagement prior to implementation. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in PCP Chiropractor Referrals for LBP | This outcome will be assessed by calculating the proportion of LBP patients receiving a chiropractic referral for the two timeframe periods will be calculated. The numerator will be those with a chiropractic referral, defined as those LBP patients who received a PCP referral in the EHR or documentation in the EHR of a visit with a chiropractor. The denominator will be the total number of unique LBP patients seen by a PCP with an LBP diagnosis in the EHR. | During the fourteen month study period |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of patient participants referred to physical therapy | Information for this outcome will be abstracted from the participants' medical records | 14 months |
| Percentage of patient participants referred to acupuncture |
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Inclusion criteria for CHCs:
Inclusion criteria for PCPs:
Inclusion criteria for patients with LBP:
Exclusion criteria for CHCs:
Exclusion criteria for PCPs:
Exclusion criteria for patients with LBP:
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| Name | Affiliation | Role |
|---|---|---|
| Eric J Roseen, DC | Boston Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Boston Medical Center | Boston | Massachusetts | 02118 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39979943 | Derived | Roseen EJ, Bussieres A, Reichman R, Bora C, Trieu J, Austad K, Williams C, Fischer RA, Parrilla D, Laird LD, LaValley M, Evans RL, Saper RB, Morone NE. A multi-level implementation strategy to increase adoption of chiropractic care for low back pain in primary care clinics: a randomized stepped-wedge pilot study protocol. Chiropr Man Therap. 2025 Feb 20;33(1):9. doi: 10.1186/s12998-024-00565-w. |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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This is a stepped-wedge design. 3 CHCs will be randomized to receive the intervention either first, second, or third two months apart.
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| PCPs interventions | Other | Two one-hour interactive grand rounds/lunch seminars that allow for inter-professional learning for PCPs with optional continuing education credits for PCPs. Short teaching cases involving clinical vignettes developed with local doctors of chiropractic (DCs), information about DCs (e.g., evidence-base for treatments), and logistics of the referral process (e.g., geographic location of community-based DCs who accept Medicaid) sent to participating providers unable to attend the seminars. Additional strategies may be added depending on primary care provider engagement prior to implementation. |
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| Patient interventions | Other | Printed and electronic educational materials (e.g., brochures) written at a sixth grade reading level in English and Spanish that present chiropractic as a safe and effective evidence-based treatment for LBP. These materials will be written, reviewed, and revised by the researchers with CHC patient input. Additional strategies may be added depending on patient engagement prior to implementation. |
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Information for this outcome will be abstracted from the participants' medical records
| 14 months |
| Percentage of patient participants prescribed opioids | Information for this outcome will be abstracted from the participants' medical records | 14 months |
| Percentage of patient participants referred to magnetic resonance imaging (MRI) | Information for this outcome will be abstracted from the participants' medical records | 14 months |
| Percentage of patient participants that receive epidural injections | Information for this outcome will be abstracted from the participants' medical records | 14 months |
| D013568 |
| Pathological Conditions, Signs and Symptoms |