Chiropractic and medical care costs of low back care: results from a practice-based observational study.

Objective: To compare the 1-year costs for patients treated for acute and chronic ambulatory low back pain by medical physicians and chiropractors.

Study Design: Prospective, practice-based observational study undertaken in 13 general medical practices and 51 chiropractic community-based clinics.

Patients And Methods: Of 2872 study patients, 2263 had complete 1-year records of services.

Data management in practice-based research.

Objective: Multi-site data collection is complex and requires an effective data management system. This article explores data management issues encountered in the design, conduct, and analysis of a research project involving 74 community-based sites and a central data management system.

Results: Once the data arrived at the central site, data integrity was maintained at a very high level.

One-year trend in pain and disability relief recall in acute and chronic ambulatory low back pain patients.

Clinicians use patients' recall of pain and disability relief as indicators of therapeutic effectiveness. Recall can change over time, however, and is influenced by factors other than true relief, including current health status. We have determined the trend in the relative contribution of current pain/disability and actual relief (current-baseline score) to relief recall over the course of 1 year.

A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: management by physicians (practice activities) and patients (self-management).

Background: A practice-based study of ambulatory patients with low back pain noted a long-term outcome advantage for self-referred chiropractic (DC) patients over medical (MD) patients within a subgroup of patients with chronic low back pain and radiating pain below the knee. The frequency of self-care education by physicians in both provider cohorts coupled with current thinking on management of chronic low back pain led to an exploration and description of physicians' noncore practice activities and patients' self-management attitudes and behaviors.

Methods: A longitudinal, practice-based, observational study was undertaken in 14 general practice and 51 chiropractic community-based clinics.

Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians.

Background: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain.

Objective: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome.

Methods: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin.

Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians.

Background: Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients.

Objectives: To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians.

Practice-based research: the Oregon experience.

Background: Practice-based research links community-based physicians and their patients with investigators at academic institutions. In 1992, Western States Chiropractic College developed an infrastructure, the Center for Outcomes Studies, to support practice-based research. The Low Back Pain Study, undertaken in collaboration with Oregon Health Sciences University, 111 medical physicians, and 60 chiropractors, relied on the Center for Outcomes Studies infrastructure for support in project implementation and maintenance.

Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study.

Background: Chronic low-back pain is a significant public health problem for which few therapies are supported by predictable outcomes. In this report, practice activities and 1-month outcomes data are presented for 93 chiropractic patients and 45 medical patients with chronic, recurrent low-back pain.

Design: A prospective, observational, community-based feasibility study involving chiropractors and family medicine physicians.

Chiropractic radiologists: a survey of chiropractors' attitudes and patterns of use.

Objective: To assess the chiropractic use of radiography, referral patterns to both medical and chiropractic radiologists and attitudes toward radiologists.

Design: Random sample mail survey.

Participants: Practicing U.

Outcomes research in chiropractic: the state of the art and recommendations for the chiropractic research agenda.

Objective: To examine and document the state of the art in outcomes research in chiropractic, including the limitations of available data, and to make recommendations for further progress in this area.

Methodology: An extensive search of the literature from 1990 through 1994 was undertaken using electronic databases (Medline, Index to Chiropractic Literature, EMBASE, and ERIC) and hand searches were conducted for relevant studies published in 1995. Publication in English, publication in a peer-reviewed journal, weight of evidence (study design) and measurement of patient-relevant outcomes were primary inclusion criteria.

The role of chiropractors in the delivery of interdisciplinary health care in rural areas.

Objective: To examine the current and potential role of chiropractors in rural interdisciplinary health care teams.

Design: Information was gathered from three sources to summarize rural health care delivery needs and interdisciplinary practice as they relate to chiropractic to develop a position statement: a literature review, a series of semistructured phone interviews with health care providers and a workshop for interdisciplinary health care practitioners, rural chiropractors and chiropractic college faculty.

Results: The health care needs of rural populations are diverse and not adequately addressed in the current system.

The descriptive profile of low back pain patients of field practicing chiropractors contrasted with those treated in the clinics of west coast chiropractic colleges.

Objective: To compare the demographic and clinical characteristics of low back pain patients from chiropractic college clinics and private practice settings on the west coast of the United States.

Design And Setting: A survey analysis of consecutive new patients in a specified time frame from multiple private office settings contrasted with a previous survey of consecutive new patients in a similar time frame from chiropractic college clinics.

Patients: In the private practice setting, new patients were selected on a consecutive basis as subjects for the study.

Lumbar motion trends and correlation with low back pain. Part II. A roentgenological evaluation of quantitative segmental motion in lateral bending.

Objective: A radiographic study was undertaken to describe the relationship between the magnitude of coupled lumbar motion in lateral bending and the presence of low back pain: correlation between pain and motion, relationship between motion category and motion and symmetry of lumbar motion.

Design: Survey.

Setting: Chiropractic college student health center and private chiropractic clinic.

Lumbar motion trends and correlation with low back pain. Part I. A roentgenological evaluation of coupled lumbar motion in lateral bending.

Objective: A radiographic study was undertaken to describe the relationship between coupled lumbar motion in lateral bending and the presence of low back pain symptomatology, evaluate trends of coupled motion and determine if these trends were attributable to chance confluence of independent motions.

Design: Survey.

Setting: Chiropractic college student health center and private chiropractic clinic.

Diagnostic utility of the McGill Pain Questionnaire and the Oswestry Disability Questionnaire for classification of low back pain syndromes.

Verbal pain description and assessment of functional limitations are key components in the clinical evaluation of patients with low back pain syndromes. Using the McGill Pain Questionnaire (MPQ) to quantify the pain experience and the Oswestry Disability Questionnaire (ODQ) to quantify functional disability, a study was undertaken to determine the efficiency with which the MPQ and ODQ were capable of enhancing the differential diagnosis of three broad categories of low back syndromes. Three discriminative models were employed.

Disabling low back Oregon workers' compensation claims. Part III: Diagnostic and treatment procedures and associated costs.

Claimants in Oregon with disabling low back injuries attending chiropractors were found to have more treatments over a longer duration and at greater cost than claimants attending medical physicians with similar clinical presentations. These findings are attributed to: a) a higher proportion of chiropractic claimants than medical physician claimants with low back risk factors which may have adversely affected the course of recovery (chronic or recurrent low back conditions, obesity, extremity symptomatology, frequency of exacerbations); b) differences in age and gender of DC and MD claimants; c) the greater physician-patient contact hours characteristic of chiropractic practice; d) differences in therapeutic modalities employed; and e) the physician reimbursement permitted under Oregon workers' compensation law. The findings of this study emphasize the need for prospective studies of treatment outcome.

Disabling low back Oregon Workers' Compensation claims. Part II: Time loss.

This paper reports on time loss incurred by chiropractic (DC) and medical (MD) claimants with disabling low back work-related injuries in Oregon. Clinical categorization was accomplished using medical records and was based on reported symptomatology, objective clinical findings and functional impairment. The median time loss days for cases with comparable clinical presentation (severity) was 9.

Disabling low back Oregon workers' compensation claims. Part I: Methodology and clinical categorization of chiropractic and medical cases.

This paper reports on a case-control study of 201 randomly selected workers' compensation cases involving disabling low back injuries. To control for claim severity prior to comparison studies on time loss and treatment cost, a classification scheme based on documented clinical signs and symptoms was used to subgroup the claims from two provider groups, chiropractic (DC) and medical (MD), into three categories of clinical presentation. Soft tissue strain/sprain predominated in both provider groups.

A comparison of low back pain profiles of chiropractic teaching clinic patients with patients attending private clinicians.

A study was undertaken at six chiropractic college outpatient (teaching) clinics and 60 private chiropractic clinics, to evaluate the comparability of patients' pain quality and pain intensity in each of three low back pain diagnostic groups. The McGill Pain Questionnaire (MPQ) was employed for this purpose. There was a tremendous range of measurable pain characteristics (Pain Rating Index scores) within the three diagnostic groups in both patient samples.

Interrater reliability of roentgenological evaluation of the lumbar spine in lateral bending.

Interrater reliability is described for the evaluation of lumbar motion and motion coupling patterns in lateral bending. Upright neutral and lateral bending lumbar films of 58 student volunteers were marked by three examiners. Segmental tilt, segmental rotation and motion categories were computed.

A comparison of patients and patient complaints at six chiropractic college teaching clinics.

A cooperative study was undertaken by six chiropractic colleges for the purpose of studying similarities and/or differences among the patients and patient complaints at the college outpatient (teaching) clinics. There were some notable differences among the clinics with respect to the standard demographic variables of age, education, employment and income. The sociodemographic characteristics of patients appeared to be different to the extent that the characteristics of the neighborhoods in which the clinics were located were different.

Visit characteristics of 217 children attending a chiropractic college teaching clinic.

The visit characteristics of 217 children attending a chiropractic teaching clinic are described. Forty-two percent suffered from musculoskeletal complaints, 20% from nonmusculoskeletal complaints and 33% attended the clinic for general physical examination. Patients who were members of the immediate family of a student intern were more likely to attend the clinic for general physical examination or for nonmusculoskeletal complaints.