Dissertation
Chiropractic care for US active-duty military members with low back pain: determining how and for whom it is effective
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2023
DOI: 10.25820/etd.007068
Abstract
Low back pain is a significant public health burden. It is both a leading cause of disability worldwide and one of the most expensive conditions to manage in the US. It is highly prevalent in the US military and a common cause of combat duty interruption. Clinical practice guidelines recommend non-invasive, non-drug therapies, typical of chiropractic care, for the treatment of low back pain. Previous work has demonstrated a benefit on low back pain intensity and pain- related disability when adding chiropractic care to usual medical care for US active-duty military members. The aim of this work is to explore how and for whom these effects occur.
We conducted secondary analyses of data from a pragmatic, multi-site trial comparing 6 weeks of treatment with usual medical care plus chiropractic care to usual medical care alone for US active-duty military members with low back pain. Natural effect, multiple mediator models were conducted to evaluate mediation of 12-week pain interference and pain intensity by 6-week biopsychosocial factors and vice versa. Linear mixed-effect regression models over baseline, 6, and 12 weeks were used to evaluate effect modifier x treatment x time interaction terms. When applicable, analyses were adjusted for factors such as baseline sex, age, site, low back pain duration, physical function, fatigue, sleep disturbance, anxiety, depression, satisfaction with participation in social role, pain interference, and pain intensity.
Moderate mediation of effect on pain occurred through mostly physical and social factors. Most of the effect on biopsychosocial factors occurred through pain intensity. Fatigue and anxiety were important effect modifiers of chiropractic care on pain at 12 weeks.
Chiropractic care improves outcomes for US active-duty military members mostly through effects on pain intensity leading to changes in other quality of life factors. Chiropractic care should be added to usual medical care for active-duty military members with higher levels of fatigue and anxiety to improve pain outcomes for these patients. Future work should determine if mechanisms and effect modifiers differ in non-military populations.
Details
- Title: Subtitle
- Chiropractic care for US active-duty military members with low back pain: determining how and for whom it is effective
- Creators
- Zacariah Shannon
- Contributors
- Ryan Carnahan (Advisor)Carri Casteel (Committee Member)Elizabeth Chrischilles (Committee Member)Christine Goertz (Committee Member)Cynthia Long (Committee Member)Robert Wallace (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Spring 2023
- DOI
- 10.25820/etd.007068
- Publisher
- University of Iowa
- Number of pages
- x, 95 pages
- Copyright
- Copyright 2023 Zacariah Shannon
- Language
- English
- Date submitted
- 04/23/2023
- Date approved
- 06/30/2023
- Description illustrations
- illustrations, tables, graphs
- Description bibliographic
- Includes bibliographical references (pages 87-95).
- Public Abstract (ETD)
- Low back pain is a top cause of disability worldwide and common for US military members. Non-invasive and non-drug approaches, typical in chiropractic care, are recommended for low back pain treatment. This work aimed to learn more about how and for whom chiropractic care is effective when added to usual medical care for US active-duty military members with low back pain. We examined the effect of chiropractic care on pain that occurs through changes in physical, mental, and social factors, and vice versa. We also evaluated if higher to lower levels of physical, mental, and social health before treatment affected the amount of improvement in pain over time. A moderate amount of the effect of chiropractic care on pain occurred through mostly physical and social factors. A large amount of the effect on physical, mental, and social factors occurred through changes in pain intensity and pain interference. The level of fatigue and anxiety prior to treatment affected the amount of improvement in pain over time. The strengths of this work were using clinical trial data and considering physical, mental, and social factors. The limitations were not having information on patient beliefs and few participants with mental health symptoms. Improvement for US military members due to chiropractic care mostly occurs through effects on pain leading to improvement in other quality of life factors. To achieve better low back pain outcomes for US military members, chiropractic care should be added to medical care for those with greater fatigue symptoms.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984424791102771
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