Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors

Zacariah K. Shannon; Cynthia R. Long; Elizabeth A. Chrischilles; Christine M. Goertz; Robert B. Wallace; Carri Casteel; Ryan M. Carnahan

doi:10.1371/journal.pone.0310642

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Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors

Zacariah K. Shannon, Cynthia R. Long, Elizabeth A. Chrischilles, Christine M. Goertz, Robert B. Wallace, Carri Casteel and Ryan M. Carnahan

PloS one, Vol.19(10), e0310642

10/01/2024

DOI: 10.1371/journal.pone.0310642

PMCID: PMC11444394

PMID: 39352877

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Abstract

This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. Mediation of the adjusted mean effect difference on 12-week outcomes of PROMIS-29 pain interference and intensity by 6-week mediators of other PROMIS-29 physical, mental, and social health subdomains was evaluated. The effect difference on pain interference occurring through PROMIS-29 biopsychosocial factors (natural indirect effect = -1.59, 95% CI = -2.28 to -0.88) was 56% (95% CI = 35 to 96) of the total effect (-2.82, 95% CI = -3.98 to -1.53). The difference in effect on pain intensity occurring through biopsychosocial factors was smaller (natural indirect effect = -0.32, 95% CI = -0.50 to -0.18), equaling 26% (95% CI = 15 to 42) of the total effect (-1.23, 95% CI = -1.52 to -0.88). When considered individually, all physical, mental, and social health factors appeared to mediate the effect difference on pain interference and pain intensity with mental health factors having smaller effect estimates. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.

Details

Title: Subtitle: Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors
Creators: Zacariah K. Shannon - Palmer College of Chiropractic
Cynthia R. Long - Palmer College of Chiropractic
Elizabeth A. Chrischilles - University of Iowa
Christine M. Goertz - Duke University Hospital
Robert B. Wallace - University of Iowa
Carri Casteel - University of Iowa
Ryan M. Carnahan - University of Iowa
Contributors: Bernard X.W. Liew (Editor)
Resource Type: Journal article
Publication Details: PloS one, Vol.19(10), e0310642
DOI: 10.1371/journal.pone.0310642
PMID: 39352877
PMCID: PMC11444394
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: PUBLIC LIBRARY SCIENCE
Grant note: The author(s) received no specific funding to conduct this work. This work received the NCMIC Early Career Award at the 2023 WFC Biennial Congress."
Language: English
Date published: 10/01/2024
Academic Unit: Pharmacy; Occupational and Environmental Health; Epidemiology; Nursing; Injury Prevention Research Center
Record Identifier: 9984721241402771

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