Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process

Anthony J. Lisi; Stacie A. Salsbury; Cheryl Hawk; Robert D. Vining; Robert B. Wallace; Richard Branson; Cynthia R. Long; A. Lucille Burgo-Black; Christine M. Goertz

doi:10.1016/j.jmpt.2017.10.001

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Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process

Anthony J. Lisi, Stacie A. Salsbury, Cheryl Hawk, Robert D. Vining, Robert B. Wallace, Richard Branson, Cynthia R. Long, A. Lucille Burgo-Black and Christine M. Goertz

Journal of manipulative and physiological therapeutics, Vol.41(2), pp.137-148

02/2018

DOI: 10.1016/j.jmpt.2017.10.001

PMCID: PMC6103526

PMID: 29482827

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Abstract

The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.

Chiropractic

Veterans

Delivery of Health Care

Interprofessional Relations

Spinal Manipulation

Details

Title: Subtitle: Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process
Creators: Anthony J. Lisi - VA Connecticut Healthcare System
Stacie A. Salsbury - Palmer College of Chiropractic
Cheryl Hawk - Texas Chiropractic College
Robert D. Vining - Palmer College of Chiropractic
Robert B. Wallace - University of Iowa
Richard Branson - Minneapolis VA Health Care System
Cynthia R. Long - Palmer College of Chiropractic
A. Lucille Burgo-Black - Yale School of Medicine
Christine M. Goertz - Palmer College of Chiropractic
Resource Type: Journal article
Publication Details: Journal of manipulative and physiological therapeutics, Vol.41(2), pp.137-148
DOI: 10.1016/j.jmpt.2017.10.001
PMID: 29482827
PMCID: PMC6103526
NLM abbreviation: J Manipulative Physiol Ther
ISSN: 0161-4754
eISSN: 1532-6586
Publisher: Elsevier Inc
Language: English
Date published: 02/2018
Academic Unit: Epidemiology; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984364442502771

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