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

Publication ,  Journal Article
Goertz, CM; Salsbury, SA; Long, CR; Vining, RD; Andresen, AA; Hondras, MA; Lyons, KJ; Killinger, LZ; Wolinsky, FD; Wallace, RB
Published in: BMC Geriatr
October 13, 2017

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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Published In

BMC Geriatr

DOI

EISSN

1471-2318

Publication Date

October 13, 2017

Volume

17

Issue

1

Start / End Page

235

Location

England

Related Subject Headings

  • Quality of Life
  • Prospective Studies
  • Professional Practice
  • Primary Health Care
  • Pilot Projects
  • Patient-Centered Care
  • Patient Satisfaction
  • Manipulation, Chiropractic
  • Male
  • Low Back Pain
 

Citation

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Goertz, C. M., Salsbury, S. A., Long, C. R., Vining, R. D., Andresen, A. A., Hondras, M. A., … Wallace, R. B. (2017). Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial. BMC Geriatr, 17(1), 235. https://doi.org/10.1186/s12877-017-0624-z
Goertz, Christine M., Stacie A. Salsbury, Cynthia R. Long, Robert D. Vining, Andrew A. Andresen, Maria A. Hondras, Kevin J. Lyons, Lisa Z. Killinger, Fredric D. Wolinsky, and Robert B. Wallace. “Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial.BMC Geriatr 17, no. 1 (October 13, 2017): 235. https://doi.org/10.1186/s12877-017-0624-z.
Goertz CM, Salsbury SA, Long CR, Vining RD, Andresen AA, Hondras MA, et al. Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial. BMC Geriatr. 2017 Oct 13;17(1):235.
Goertz, Christine M., et al. “Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial.BMC Geriatr, vol. 17, no. 1, Oct. 2017, p. 235. Pubmed, doi:10.1186/s12877-017-0624-z.
Goertz CM, Salsbury SA, Long CR, Vining RD, Andresen AA, Hondras MA, Lyons KJ, Killinger LZ, Wolinsky FD, Wallace RB. Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial. BMC Geriatr. 2017 Oct 13;17(1):235.
Journal cover image

Published In

BMC Geriatr

DOI

EISSN

1471-2318

Publication Date

October 13, 2017

Volume

17

Issue

1

Start / End Page

235

Location

England

Related Subject Headings

  • Quality of Life
  • Prospective Studies
  • Professional Practice
  • Primary Health Care
  • Pilot Projects
  • Patient-Centered Care
  • Patient Satisfaction
  • Manipulation, Chiropractic
  • Male
  • Low Back Pain