Chiropractic

FY 2005 Chiropractic Demonstration Projects Grantee Abstracts

Organization Name: Palmer Chiropractic University
Address: Palmer Center for Chiropractic Research
741 Brady Street
Davenport, IA 52803
Project Director: William Meeker, DC, MPH
Phone: 563-884-5162
Fax: 563-884-5227
E-Mail: Meeker_b@palmer.edu
Project Title: Elderly Back Pain: Comparing Chiropractic to Medical Care
Grant Number: R18HP01423
Project Period: 9/1/03 – 8/31/06
FY 2005 Award Amount: $369,572

Abstract Narrative:

Low back pain (LBP) in the elderly is a significant public health problem with prevalence ranging from 13-49%. Despite significant impact on elderly quality of life, there are no randomized clinical trials (RCT) examining medical and chiropractic treatment options. We propose a prospective (RCT) of 250 elderly patients with subacute or chronic LBP. Patients will be randomized to one of three treatment conditions: 1) chiropractic care consisting of high-velocity low amplitude (HVLA) spinal adjustments (manipulation), 2) chiropractic care consisting of low-velocity variable amplitude (LVVA) spinal mobilization (flexion-distraction) and 3) standard medical care. All patients also receive a standardized regimen of home exercises and stretching. The primary outcome at six weeks is the Roland Morris Back Disability Questionnaire, a validated measure of pain and disability used in many LBP RCTs. The study is statistically powered for two separate primary comparisons: 1) chiropractic care versus medical care and 2) HVLA manipulation versus LVVA mobilization. Secondary measurements include pre and post treatment biomechanical assessments of postural sway, the sit-to-stand maneuver, and spinal stiffness. In addition, we will measure the three-dimensional forces (loads and moments) delivered by chiropractic manipulation and mobilization in order to quantify the dosage and variation in manipulation/mobilization. The two primary analyses have the potential to inform and improve medical and chiropractic clinical practice. The biomechanical measurements will be useful for developing hypotheses regarding how LBP and manipulative loads affect muscle and joint physiology, especially in the elderly, and could lead to better integration between the basic and clinical sciences in the area of spinal care research. The Palmer Center for Chiropractic Research (PCCR) has developed a considerable infrastructure to conduct RCTs, and investigators at PCCR have significant experience conducting both clinical and biomechanical research. The PCCR is the largest and most comprehensive chiropractic research effort in the U.S., and it is well-positioned and highly experienced at medical/chiropractic collaboration. PCCR is partnering with community-based medical physicians and the Departments of Internal Medicine and Biomechanical Engineering at the University of Iowa to conduct this study.

Organization Name: Northwestern Health Sciences University
Address: 2501 W. 84^th Street
Bloomington, MN 55431
Project Director: Gert Bronfort, DC, PhD
Phone: 952-884-5413
Fax: 952-888-1957
E-Mail: gbronfort@nwhealth.edu
Project Title: Chiropractic and Exercise for Seniors with Low Back Pain
Grant Number: R18HP01424
Project Period: 9/1/03 – 8/31/06
FY 2005 Award Amount: $464,883

Abstract Narrative:

Low back pain (LBS) is a significant health problem for both young and geriatric individuals. Of particular concern is that conditions associated with LBP, such as impaired strength and flexibility, can have very serious consequences for an older individuals’ independence and overall health. Chiropractic and exercise treatments aim to correct such impairments and have demonstrated their potential in younger individuals with LBP. However, these promising treatments have yet to be rigorously evaluated in elder LBP sufferers.

The broad, long-term objective of this research is to identify effective therapies for low back pain and to discover the best methods for enhancing health and functional capacity in patients 65 years of age and older with low back pain of more than 6 weeks duration.

Primary Aims

• To determine the relative clinical effectiveness of 1) chiropractic manual treatment and home exercises, 2) supervised rehabilitative exercise and home exercise, 3) home exercise alone in both the short-term (after 12 weeks) and long-term (after 52 weeks), using low back pain as the main outcome measure.

Secondary Aims

• To estimate the short- and long-term relative effectiveness of the three interventions using:
  • Patient-rated outcomes: low back disability, general health status, patient satisfaction, improvement and medication use measured by self-report questionnaires;
  • Objective functional performance outcomes: spinal motion, trunk endurance, and functional ability measured by examiners masked to treatment group assignment;
  • Cost measures: direct and indirect costs of treatment measured by questionnaires, phone interviews, and medical records.
• To describe patients’ perceptions of treatment and the issues they consider when determining their satisfaction with care.

This project is the collective effort of a multidisciplinary team, with an established record of collaborative research in the area of neck and back pain. The results of this trial will provide valuable information on the treatment and management of LBP in the elderly population.

Organization Name: Northwestern Health Sciences University
Address: 2501 W. 84^th Street
Bloomington, MN 55431
Project Director: Gert Bronfort, DC, PhD
Phone: 952-884-5413
Fax: 952-888-1957
E-Mail: gbronfort@nwhealth.edu
Project Title: Chiropractic and Exercise for Seniors with Neck Pain
Grant Number: R18HP01425
Project Period: 9/1/03 – 8/31/06
FY 2005 Award Amount: $473,373

Abstract Narrative:

Neck pain (NP) is a considerable health problem, affecting both young and elderly individuals. Of particularly concern is the negative impact NP may have on the functional ability of the geriatric population, already challenged by decreased mobility and balance associated with aging. Chiropractic manual treatment and rehabilitative exercise have demonstrated potential for the treatment of NP in younger individuals, but have yet to be rigorously tested in the elderly.

The broad, long-term objective of this research is to identify effective therapies for patients, 65 and older, who suffer with chronic neck pain and to enhance their functional capacity.

Primary Aims

• To determine the relative clinical effectiveness of 1) chiropractic manual treatment and home exercises, 2) supervised rehabilitative exercise and home exercise, 3) home exercise alone in both the short-term (after 12 weeks) and long-term (after 52 weeks), using patient-rated neck pain as the main outcome measure.

Secondary Aims

• To estimate the short- and long-term relative effectiveness of the three interventions using:
  • Patient-rated outcomes: neck related disability, general health status, patient satisfaction, improvement and medication use measured by self-report questionnaires;

• Objective functional performance outcomes: neck motion, strength and endurance, and functional ability measured by examiners masked to treatment group assignment.
• Cost measures: direct and indirect costs and cost utility of treatment measured by questionnaires, phone interviews, and medical records.
• To describe patients’ perceptions of treatment and the issues they consider when determining their satisfaction with care.

This project is a collective effort by a multidisciplinary team, with an established record of collaborative research in the area of neck and back pain. The results of this study will provide valuable information for elderly neck pain sufferers and the clinicians who treat them.