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Do Different Doses of Chiropractic Care Help Veterans with Chronic Low Back Pain? Results from Phase 1 of the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) Pragmatic Randomized Trial
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Do Different Doses of Chiropractic Care Help Veterans with Chronic Low Back Pain? Results from Phase 1 of the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) Pragmatic Randomized Trial

Christine Goertz, Stacie Salsbury, Robert Vining, Erin Krebs, Thad Abrams, Paul Shekelle, Robert Wallace, Jon Lurie, Anthony Lisi and Cynthia Long
The journal of pain, Vol.41(Supplement), 105683
03/2026
DOI: 10.1016/j.jpain.2025.105683

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Abstract

The Phase 1 VERDICT pragmatic randomized trial evaluated effectiveness of higher-dose (8-12 visits) versus lower-dose (1-5 visits) chiropractic care over 10-weeks for veterans with chronic low back pain. VERDICT enrolled 766 veterans from 4 geographically diverse VA sites; mean age was 51 years (22-87), 21% were female and 30% were racial/ethnic minorities. The primary outcome, Roland Morris Disability Questionnaire (RMDQ), was modeled as a responder analysis (≥ 30% improvement from baseline to 10-weeks) with a modified Poisson regression. Secondary outcomes, including average LBP intensity; Pain, Enjoyment and General activity (PEG); and PROMIS domains, were modeled over time with mixed-effects regression. All models were adjusted for site, age, sex, baseline LBP intensity and adherence to allocated dose. Participants had high levels of LBP-related disability (mean baseline RMDQ: 12.2), moderate pain intensity, and high levels of co-morbidities. The relative risk of being a responder on RMDQ in the higher versus lower dose group was 1.28 (95% CI: 1.08 to 1.53). The higher versus lower dose group also had more improvement in pain intensity (difference in mean change: 0.28; 95% CI:0.02 to 0.55), PEG (0.42; 0.13 to 0.70); and PROMIS global physical health (1.12; 0.34 to 1.89). Veterans with chronic low back pain responded better to higher dose chiropractic care over an initial 10-week period for physical functioning, pain intensity and pain severity. The effect size of the primary outcome was moderate. Other differences were small but consistently positive. VERDICT is registered at clinicaltrials.gov (NCT04087291). Funding: National Institutes of Health (UH3AT009761).

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