Supporting Research in Pain Management for Veterans and Military Service Members
Supporting Research in Pain Management for Veterans and Military Service Members

VERDICT Trial Study Group Develops Clinical Decision Aid for Managing Low Back Pain

Cristine Goertz, DC, PhD, Co-PI of the PMC VERDICT trial is co-author on an article designed to be a decision aid for doctors of chiropractic managing low back pain. Goertz, and the other authors, used an online modified Delphi technique and Research Electronic Data Capture web application to conduct a consensus study among 39 VA doctors of chiropractic to determine their familiarity with evidence-based care interventions for veterans with low back pain. The measures used resulted in a scientifically based four-page clinical aid for making chiropractic care decisions, although the study itself offers many practical applications, including clear definitions of evidence-based treatment options, and an emphasis on patient education and multi-modal care plans. The decision aid will be used in a clinical trial within Veterans Affairs health care facilities.

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

Robert D. Vining, DC, DHSc, Zacariah K. Shannon, DC, MS, Stacie A. Salsbury, PHD, RN, Lance Corber, MSITM, Amy L. Minkalis, DC, MS, and Christine. M. Goertz, DC, PhD

Journal of Manipulative and Physiological Therapeutics – March 2019


Objective: The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities.

Methods: A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range.

Results: Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool.

Conclusion: This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP. (J Manipulative Physiol Ther 2019;xx:1-17)

Key Indexing Terms: Decision Support Techniques; Low Back Pain; Chiropractic; Complementary Therapies; United States; Consensus; Veterans

Link to full article and care decision aid.