Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services: A Description of Integration of Chiropractors as Service Providers

J Manipulative Physiol Ther. Nov-Dec 2017;40(9):635-642. doi: 10.1016/j.jmpt.2017.07.011.

Abstract

Objective: The purpose of this study was to evaluate a chiropractic service for back pain patients integrated within a publicly funded, multidisciplinary, primary care community health center in Cambridge, Ontario, Canada.

Methods: Patients consulting for back pain of any duration were referred by their medical doctor or nurse practitioner for chiropractic treatment at the community health center. Patients completed questionnaires at baseline and at discharge from the service. Data were collected prospectively on consecutive patients between January 2014 and January 2016.

Results: Questionnaire data were obtained from 93 patients. The mean age of the sample was 49.0 ± 16.27 years, and 66% were unemployed. More than three-quarters (77%) had had their back pain for more than a month, and 68% described it as constant. According to the Bournemouth Questionnaire, Bothersomeness, and global improvement scales, a majority (63%, 74%, and 93%, respectively) reported improvement at discharge, and most (82%) reported a significant reduction in pain medication. More than three-quarters (77%) did not visit their primary care provider while under chiropractic care, and almost all (93%) were satisfied with the service. According to the EuroQol 5 Domain questionnaire, more than one-third of patients (39%) also reported improvement in their general health state at discharge.

Conclusion: Implementation of an integrated chiropractic service was associated with high levels of improvement and patient satisfaction in a sample of patients of low socioeconomic status with subacute and chronic back pain.

Keywords: Back Pain; Chiropractic; Community Health Centers; Health Services Research.

MeSH terms

  • Adult
  • Aged
  • Canada
  • Community Health Centers / organization & administration*
  • Community Health Services / standards
  • Community Health Services / trends
  • Delivery of Health Care, Integrated / organization & administration*
  • Female
  • Health Care Surveys
  • Health Personnel / organization & administration*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / rehabilitation*
  • Male
  • Manipulation, Chiropractic*
  • Middle Aged
  • Ontario
  • Outcome Assessment, Health Care
  • Prospective Studies