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BMC Geriatrics
Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research Article

Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial

Authors: Christine M. Goertz, Stacie A. Salsbury, Cynthia R. Long, Robert D. Vining, Andrew A. Andresen, Maria A. Hondras, Kevin J. Lyons, Lisa Z. Killinger, Fredric D. Wolinsky, Robert B. Wallace

Published in: BMC Geriatrics | Issue 1/2017

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Abstract

Background

Low 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.

Methods

We 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.

Results

At 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.

Conclusions

Professional 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 registration

Clinicaltrials.gov, NCT01312233, 4 March 2011.
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Metadata
Title
Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial
Authors
Christine M. Goertz
Stacie A. Salsbury
Cynthia R. Long
Robert D. Vining
Andrew A. Andresen
Maria A. Hondras
Kevin J. Lyons
Lisa Z. Killinger
Fredric D. Wolinsky
Robert B. Wallace
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0624-z

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