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

    Anthony J Lisi                 ¹              , Stacie A Salsbury                 ²              , Cheryl Hawk                 ³              , Robert D Vining                 ²              , Robert B Wallace                 ⁴              , Richard Branson                 ⁵              , Cynthia R Long                 ²              , A Lucille Burgo-Black                 ⁶              , Christine M Goertz                 ⁷                

        Affiliations        

•                       PMID:            29482827            
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•                       PMCID:                  PMC6103526                
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•                       DOI:                  10.1016/j.jmpt.2017.10.001                

        Abstract              

                        Objective:                    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.    

                        Methods:                    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.    

                        Results:                    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.    

                        Conclusion:                    This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.    

                        Keywords:                    Chiropractic; Delivery of Health Care; Interprofessional Relations; Spinal Manipulation; Veterans.    

    Copyright © 2018. Published by Elsevier Inc.  

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      Conflict of interest statement    

Conflicts of Interest

Drs. Lisi, Branson, and Burgo-Black reported nothing to disclose.