ClinicalTrials.gg
CompletedNCT03254719COCOVUpdated May 18, 2020Results posted

Care Outcomes for Chiropractic Outpatient Veterans

An interventional study of Study assessments in Low Back Pain, PTSD and Depression, sponsored by Palmer College of Chiropractic. Completed at 4 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-05-18.

Sponsored by Palmer College of Chiropractic · Not applicable, Interventional, and Other

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Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-13

Among 11 studies in Low Back Pain by Palmer College of Chiropractic — none open to participants now, none under way, none of them phase 3. Low Back Pain · Palmer College of Chiropractic.

Enrollment
7th of 11
40 · median 82
Started
2018
the only one that year
No phase
10 of 11
none open now
Registered
9th of 11
by date

Among the 11 studies in Low Back Pain by Palmer College of Chiropractic, this one is the 7th largest by enrollment, is the only one that started in 2018, is one of 10 with no phase, and was the 9th registered.

Low Back Pain

2,923 studies on the registry are indexed under Low Back Pain; 579 are open to participants now.

Browse Low Back Pain studies →

Open to participants now

None of the 11 studies in Low Back Pain by Palmer College of Chiropractic is open now. The open studies under Low Back Pain, anywhere →

Where they have run

Who these studies take

Of the 332 Low Back Pain studies recruiting now, 92 (28%) set no upper age limit and 210 (63%) stop at 75 or younger; 8 take children under 18; 46 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

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Download CSVNarrow it in search →With an account: the 11 studies in Low Back Pain by Palmer College of Chiropractic as a file.
02

Study summary

The primary objectives of this pilot trial are to evaluate the feasibility, safety and acceptability of an integrative care pathway that includes chiropractic care, for the coordinated care for Veterans Administration (VA) patients with chronic low back pain (cLBP), with an emphasis on those with mental health comorbidity, in preparation for the conduct of an appropriately powered multi-site randomized controlled trial (RCT). The secondary objectives are to collect study outcomes at the baseline visit (BV) and at weeks 3, 5, 7, and 10 to: 1) assess the success of collecting outcomes; 2) determine the outcome measures to use in a future RCT; and 3) determine preliminary intervention effect sizes and variability to aid in sample size determination for a future RCT. The investigators hypothesize that chiropractic care offers relief for pain and mental health symptoms through the direct effects of treatment-focused CMT, as well as through the indirect, non-specific effects of the team-based relationship with the clinician.

This pilot study is a single-arm trial. All participants will be asked to complete study outcomes which include the Roland Morris Disability Questionnaire (RMDQ), LBP intensity and interference as measured by the Defense and Veterans Pain Rating Scale (DVPRS), as well as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Alcohol Use Disorders Identification Test (AUDIT), Post-traumatic Stress Disorder Checklist-Civilian Version (PLC-C), self-care behaviors, Keele Start Back Screening Tool (STarT Back), Healing Encounters and Attitudes Lists (HEAL), Expectations for Complementary and Integrative Treatments Questionnaire (EXPECT), and Pain Intensity, Enjoyment of Life, General Activity Assessment Tool (PEG) questionnaires, and the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) assessment, which includes measures of pain, disability, mental health, quality of life enjoyment and satisfaction. All participants will receive up to 10 weeks of chiropractic care and will complete outcome assessments at weeks 3, 5, 7, and 10 of the study.

Read the detailed description

The coinciding problems of chronic pain and mental illness are of great concern for patients seeking care within the Department of Veterans Affairs (VA) healthcare facilities. Of the 5.7 million veterans treated in VA facilities in 2012, more than half reported chronic pain syndromes, including chronic low back pain (cLBP). Veterans also experience many mental health comorbidities, such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse. Veterans in pain are often managed using prescription drugs, including opioids, psychotropic medications, and sleep agents. Non-pharmacological treatments for chronic pain, which also may provide relief of mental health symptoms, may be welcomed complementary therapies for veterans suffering from these conditions.

Patients with musculoskeletal (MSK) pain and pain at multiple locations often report depression, anxiety and other mental health symptoms. Chronic pain may perpetuate mental health comorbidity as these conditions share common pathophysiological pathways. Research has shown that the non-specific effects of empathetic doctor communication and therapeutic alliance improves clinical outcomes. The investigators hypothesize that chiropractic care offers relief for pain and mental health symptoms through the direct effects of treatment-focused chiropractic manipulative therapy (CMT), as well as through the indirect, non-specific effects of the team-based relationship with the clinician.

However, chiropractic care is not delivered in isolation from other treatments within the VA. Thus, the investigators will test a feasible, effective, patient-centered, guideline-based, integrative care model that integrates chiropractic into VA Patient Aligned Care Teams (PACTs). This integrative care pathway will involve primary care providers, mental health professionals, and doctors of chiropractic (DCs) engaged in the treatment of veterans with cLBP, with or without mental health comorbidity. While DCs are providing services within VA in increasing numbers over the past 13 years, as with any new service, adoption and appropriate placement faces challenges. Many VA providers may know little about the clinical approaches used by DCs. Similarly, DCs may not be fully aware of the processes involved in the delivery of primary care services within VA or the healthcare needs of veterans with mental illness. The purpose of this pilot clinical trial is to evaluate the feasibility, safety and patient perceptions of an integrative care pathway, developed through a consensus-based process, for the coordinated care for VA patients with cLBP and mental health comorbidity.

As this is a pragmatic trial, chiropractic care will consist of usual chiropractic procedures for the management chronic low back pain (cLBP). Treatment approaches will be based on clinical evaluation, which may include diagnostic testing, to determine a working diagnosis, rule out pathology, and/or to screen for conditions requiring referral or other co-management. The investigators anticipate that chiropractic care often will include some form of chiropractic manipulative therapy (CMT). DCs will likely also recommend rehabilitative exercise, stretching, or nutritional and lifestyle advice based upon clinical findings and patient goals/preferences. The investigators will evaluate treatments through electronic health records (EHR) data abstraction following completion of chiropractic care at Week 10. As per typical VA care, DCs will monitor the participant's health status throughout the trial and initiate referrals as clinically indicated. Referrals to primary care and mental health providers will be consistent with the chiropractic integrated care pathway developed during a prior phase of the study. The investigators anticipate the most common communication and referral methods will occur through note-review and countersign procedures, which are already established among VA providers using the VA electronic health record, but may also occur in person or via phone conversations. Chiropractic care will be administered by licensed DCs who are current employees of the Iowa City VA Health Care System (ICVAHCS).

03

Conditions studied

  • Low Back Pain
  • PTSD
  • Depression
  • Anxiety

Keywords

  • Low Back Pain
  • Chiropractic
  • Veterans
  • PTSD
  • Depression
  • Anxiety
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Veterans age 18 years or older
  • Self-reported chronic LBP
  • Ability to sign form

Exclusion criteria

Exclusion Criteria:

  • Use of chiropractic care within the past 90 days
  • Impaired cognitive ability
  • Not a candidate for chiropractic care
  • Not able to attend chiropractic appointments
  • Identified as at risk for suicide
Terms in these criteria, in plain language(1)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

05

Study design

Phase
Not applicable
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
40 participants (actual)

Study arms

  • Other
    Treatment Arm

    All participants enrolled in the study will receive chiropractic care consistent with the usual chiropractic procedures for the management of chronic low back pain at the Iowa City VA Health Care System. Participants will also complete study assessments as described in outcomes.

    Other: Study assessments

Interventions

  • OtherStudy assessments

    All participants will be asked to complete study assessments at baseline visit, and weeks 3, 5, 7, and 10. Study participants will receive spinal manipulation and appropriate adjunctive therapies provided by doctors of chiropractic.

06

What researchers measure

Primary outcomes

  1. Duration of Study Recruitment

    As part of the feasibility assessment, the investigators will monitor the amount of time it takes to complete study recruitment and enrollment, and data collection. The investigators will monitor this through a data capture program.

    Time frame: From date of first participant enrolled to date last participant is enrolled, up to 8 months.

  2. Diversity of Patient Demographics

    As part of the recruitment plan, investigators are trying to target female and minority veterans. Historically these groups have been underrepresented in veteran research. The investigators will review EHR data for participant demographics.

    Time frame: Screening through baseline

  3. Number of Participants Engaged in Use of MyHealthEVet

    As part of the feasibility assessment, investigators will monitor the number of study participants who enroll in and have at least one communication with MyHealthEVet. MyHealthEVet is an online communication tool designed to partner veterans and the veteran's health care team. It provides information on the veteran's health record and health topics as well as allows messaging communication between veterans and health care providers. Usage reports generated by MyHealthEVet will be analyzed to determine number of study participants engaged.

    Time frame: 10 weeks from Baseline

  4. Acceptability

    Acceptability will be assessed by conducting structured, qualitative exit interviews with participants and providers.

    Time frame: At Week 10 of the study

  5. Number of Participants With Reported Adverse Events

    Safety for this study will be assessed by the number of adverse events counted and recorded.

    Time frame: 10 weeks from Baseline

  6. Percentage of Participants Who Did Not Attend the Initial Chiropractic Visit, Withdrew, or Are Lost to Follow-up

    As part of the feasibility assessment and ability to calculate a sample size for a full scale trial with subgroup analysis, investigators will monitor the percentage of missing data. This will include the percentage of participants who did not attend the initial chiropractic visit and withdraw or are lost to follow-up.

    Time frame: 10 weeks from Baseline

Secondary outcomes

  1. Roland Morris Low Back Pain Disability Questionnaire (RMDQ)

    The RMDQ is a widely used health status measure for low back pain. Scoring of the RMDQ ranges from 0-24, with a higher score indicating an increase in low back pain disability. (0-24, 0=No Disability, 24=Severe Disability)

    Time frame: Baseline visit and weeks 5 and 10

  2. Pain Assessment Screening Tool and Outcomes Registry (PASTOR)

    PASTOR is an on-line data collection tool based on the NIH Patient Reported Outcomes Measurement Information System (PROMIS) and adopted by the DoD/VA Pain Management Task Force. Specific measures include the Defense \& Veterans Pain Rating Scale (DVPRS), an enhanced 11-item (total range 0-10, 0=no pain, 10=worst pain) numeric rating scale (NRS) that improves on standard pain NRS by including a Faces Rating Scale component; 'traffic light' color-coding system to delineate mild, moderate and severe pain; and word descriptors, paired with 4, 0-10 NRS items to quantify the impact of pain on general activity, sleep, mood, and stress. PASTOR incorporates PROMIS measures for mental health conditions (PTSD, depression, anxiety, anger, and alcohol use), physical and social function, fatigue, and pain interference with daily activities to provide graphical representation of improvements or declines in patient status that are compared to matched US samples on age, race/ethnicity and sex.

    Time frame: Baseline visit and weeks 5 and 10

  3. STarT Back Screening Tool

    This is a 9-item, validated tool developed by Keele University to be used as a screening tool for patients with low back pain. It stratifies patients based on their prognosis of persistent disabling symptoms and allows practitioners to group patients into 3 categories (low, medium, or high risk of poor outcome).

    Time frame: Baseline visit and week 10

  4. Self-Efficacy for Managing Symptoms (SF8a)

    Developed by the Patient-Reported Outcomes Measurement Information System (PROMIS), this 8-item, self-reported tool will assess a person's level of confidence to manage/control symptoms, to manage their symptoms in different settings and to keep symptoms from interfering with work, sleep, relationships or recreational activities. Each question usually has five response options ranging in value from 1 to 5. The total raw score for a measure is converted to into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10. Therefore a person with a T-score of 40 is one SD below the mean. A higher PROMIS T-score represents more of the concept being measured. For example, a T-score of 55 on the PROMIS Self-Efficacy for Managing Symptoms indicates that the respondent has greater self-efficacy for managing their symptoms than the general chronic condition population (half a standard deviation higher).

    Time frame: Baseline visit and week 10

  5. Patient Health Questionnaire (PHQ-9)

    This instrument is self-reported with nine items and will be used to assess depressive disorder. Total scores range from 0 to 27 with a score of 10-14 considered to be in the moderate range (0-27, 0=No Depression, 27=Severe Depression). It has been tested in primary care settings and has a test-retest reliability of 0.81 to 0.96.

    Time frame: Baseline visit and week 10

  6. Generalized Anxiety Disorder-7 (GAD-7)

    This instrument is self-reported with seven items and will be used to assess generalized anxiety disorder. At a cut off score of 10 (0-21, 0=No Anxiety Disorder, 21=Severe Anxiety Disorder), it has a sensitivity of 0.89 and specificity of 0.82 for identifying patients with GAD in primary care settings.

    Time frame: Baseline visit and week 10

  7. Alcohol Use Disorders Identification Test (AUDIT)

    Developed by the World Health Organization (WHO), this 10-item screening questionnaire determines harmful or hazardous consumption of alcohol, correctly classifying 95% of people as having a clinical diagnosis of an alcohol abuse disorder (0-12, 0=No Alcohol Use).

    Time frame: Baseline visit and week 10

  8. PTSD Checklist-Civilian (PCL-C)

    This 17-item, self-reported instrument will assess PTSD. A total severity score is determined by summing scores from each of 17 items. A change of 5-10 points represents the minimum threshold for determining treatment response; a 10-20 point change represents a clinically significant change in PTSD symptom severity (17-85, 17=Not at all Severe PTSD Symptoms, 85=Extremely Severe PTSD Symptoms).

    Time frame: Baseline visit and week 10

  9. Healing Encounters and Attitudes Lists (HEAL)

    HEAL is a validated item-bank comprised of 6 domains developed through the Patient Reported Outcomes Measurement Information System (PROMIS) methodology. Investigators will use HEAL to assess nonspecific factors known to influence patient outcomes, including perceptions of the patient-provider connection, healthcare environment, treatment expectancy, spirituality, positive or negative outlook, and attitudes toward complementary and alternative medicine (CAM). A higher T-score represents more of the concept being measured. A T-score of 50 is equal to the mean and is considered normal. Lower numbers indicate values lower than the mean and higher numbers indicate values higher than the mean. Higher values are indicative of more positive perception. For example, a T-score of 55 on Patient-Provider Connection indicates that the respondent has a more positive perception toward the patient-provider connection than the general chronic condition population (half a standard deviation higher).

    Time frame: After the initial chiropractic visit

  10. Pain, Enjoyment, and General Activity (PEG)

    The PEG is a 3-item tool to improve assessment and monitoring of chronic pain. The overall PEG-3 score ranges from 0-10 with 10 indicating more pain, more interference with enjoyment of life, and more interference with general activity. Questions assess average pain intensity (P) (AVERAGE pain in past week: 0-10, 0= No Pain, 10=Pain as bad as you can imagine), interference with enjoyment of life (E), and interference with general activity (G) (In past week, how pain interfered with...(0-10, 0=Does not interfere, 10=Completely interferes).

    Time frame: Week 3 and Week 7

07

Results

Posted May 18, 2020

Participant flow

Participant flow — Overall Study
MilestoneTreatment Arm
Started40
Completed40
Not completed0

Outcome measures

PrimaryDuration of Study Recruitment

As part of the feasibility assessment, the investigators will monitor the amount of time it takes to complete study recruitment and enrollment, and data collection. The investigators will monitor this through a data capture program.

Time frame:
From date of first participant enrolled to date last participant is enrolled, up to 8 months.
Reported as:
Number · months
Duration of Study Recruitment
monthsTreatment Arm
Duration of Study Recruitment6
PrimaryDiversity of Patient Demographics

As part of the recruitment plan, investigators are trying to target female and minority veterans. Historically these groups have been underrepresented in veteran research. The investigators will review EHR data for participant demographics.

Time frame:
Screening through baseline
Reported as:
Count of participants · Participants
Diversity of Patient Demographics
ParticipantsTreatment Arm
Multi-racial1
White36
Other or unspecified3
Hispanic or Latino2
Male31
18-35 years6
36-54 years16
55+ years18
PrimaryNumber of Participants Engaged in Use of MyHealthEVet

As part of the feasibility assessment, investigators will monitor the number of study participants who enroll in and have at least one communication with MyHealthEVet. MyHealthEVet is an online communication tool designed to partner veterans and the veteran's health care team. It provides information on the veteran's health record and health topics as well as allows messaging communication between veterans and health care providers. Usage reports generated by MyHealthEVet will be analyzed to determine number of study participants engaged.

Time frame:
10 weeks from Baseline
Reported as:
Count of participants · Participants
Number of Participants Engaged in Use of MyHealthEVet
ParticipantsTreatment Arm
Number of Participants Engaged in Use of MyHealthEVet15
PrimaryAcceptability

Acceptability will be assessed by conducting structured, qualitative exit interviews with participants and providers.

Time frame:
At Week 10 of the study
Reported as:
Count of participants · Participants
Acceptability
ParticipantsTreatment Arm
Viewed as Positive10
Viewed as Mixed Positive/Negative9
Viewed as Negative5
PrimaryNumber of Participants With Reported Adverse Events

Safety for this study will be assessed by the number of adverse events counted and recorded.

Time frame:
10 weeks from Baseline
Reported as:
Count of participants · Participants
Number of Participants With Reported Adverse Events
ParticipantsTreatment Arm
Number of Participants With Reported Adverse Events6
PrimaryPercentage of Participants Who Did Not Attend the Initial Chiropractic Visit, Withdrew, or Are Lost to Follow-up

As part of the feasibility assessment and ability to calculate a sample size for a full scale trial with subgroup analysis, investigators will monitor the percentage of missing data. This will include the percentage of participants who did not attend the initial chiropractic visit and withdraw or are lost to follow-up.

Time frame:
10 weeks from Baseline
Reported as:
Count of participants · Participants
Percentage of Participants Who Did Not Attend the Initial Chiropractic Visit, Withdrew, or Are Lost to Follow-up
ParticipantsTreatment Arm
Percentage of Participants Who Did Not Attend the Initial Chiropractic Visit, Withdrew, or Are Lost to Follow-up8
SecondaryRoland Morris Low Back Pain Disability Questionnaire (RMDQ)

The RMDQ is a widely used health status measure for low back pain. Scoring of the RMDQ ranges from 0-24, with a higher score indicating an increase in low back pain disability. (0-24, 0=No Disability, 24=Severe Disability)

Time frame:
Baseline visit and weeks 5 and 10
Reported as:
Mean · score on a scale
Roland Morris Low Back Pain Disability Questionnaire (RMDQ)
score on a scaleTreatment Arm
Baseline12.9 ± 5.1
Week 510.2 ± 5.5
Week 109.6 ± 6.2
SecondaryPain Assessment Screening Tool and Outcomes Registry (PASTOR)

PASTOR is an on-line data collection tool based on the NIH Patient Reported Outcomes Measurement Information System (PROMIS) and adopted by the DoD/VA Pain Management Task Force. Specific measures include the Defense \& Veterans Pain Rating Scale (DVPRS), an enhanced 11-item (total range 0-10, 0=no pain, 10=worst pain) numeric rating scale (NRS) that improves on standard pain NRS by including a Faces Rating Scale component; 'traffic light' color-coding system to delineate mild, moderate and severe pain; and word descriptors, paired with 4, 0-10 NRS items to quantify the impact of pain on general activity, sleep, mood, and stress. PASTOR incorporates PROMIS measures for mental health conditions (PTSD, depression, anxiety, anger, and alcohol use), physical and social function, fatigue, and pain interference with daily activities to provide graphical representation of improvements or declines in patient status that are compared to matched US samples on age, race/ethnicity and sex.

Time frame:
Baseline visit and weeks 5 and 10
Reported as:
Mean · score on a scale
Pain Assessment Screening Tool and Outcomes Registry (PASTOR)
score on a scaleTreatment Arm
Worst Pain, Baseline6.4 ± 1.7
Worst Pain, Week 55.7 ± 2.0
Worst Pain, Week 105.3 ± 2.2
Average Pain, Baseline5.4 ± 1.4
Average Pain, Week 54.8 ± 1.8
Average Pain, Week 103.9 ± 2.0
SecondarySTarT Back Screening Tool

This is a 9-item, validated tool developed by Keele University to be used as a screening tool for patients with low back pain. It stratifies patients based on their prognosis of persistent disabling symptoms and allows practitioners to group patients into 3 categories (low, medium, or high risk of poor outcome).

Time frame:
Baseline visit and week 10
Reported as:
Count of participants · Participants
STarT Back Screening Tool
ParticipantsTreatment Arm
Baseline — Low Risk2
Baseline — Medium Risk17
Baseline — High Risk13
Baseline — Missing8
Week 10 — Low Risk9
Week 10 — Medium Risk12
Week 10 — High Risk7
Week 10 — Missing12
SecondarySelf-Efficacy for Managing Symptoms (SF8a)

Developed by the Patient-Reported Outcomes Measurement Information System (PROMIS), this 8-item, self-reported tool will assess a person's level of confidence to manage/control symptoms, to manage their symptoms in different settings and to keep symptoms from interfering with work, sleep, relationships or recreational activities. Each question usually has five response options ranging in value from 1 to 5. The total raw score for a measure is converted to into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10. Therefore a person with a T-score of 40 is one SD below the mean. A higher PROMIS T-score represents more of the concept being measured. For example, a T-score of 55 on the PROMIS Self-Efficacy for Managing Symptoms indicates that the respondent has greater self-efficacy for managing their symptoms than the general chronic condition population (half a standard deviation higher).

Time frame:
Baseline visit and week 10
Reported as:
Mean · score on a scale
Self-Efficacy for Managing Symptoms (SF8a)
score on a scaleTreatment Arm
Baseline41.6 ± 6.4
Week 1043.5 ± 8.2
SecondaryPatient Health Questionnaire (PHQ-9)

This instrument is self-reported with nine items and will be used to assess depressive disorder. Total scores range from 0 to 27 with a score of 10-14 considered to be in the moderate range (0-27, 0=No Depression, 27=Severe Depression). It has been tested in primary care settings and has a test-retest reliability of 0.81 to 0.96.

Time frame:
Baseline visit and week 10
Reported as:
Mean · score on a scale
Patient Health Questionnaire (PHQ-9)
score on a scaleTreatment Arm
Baseline9.7 ± 5.6
Week 108.6 ± 5.8
SecondaryGeneralized Anxiety Disorder-7 (GAD-7)

This instrument is self-reported with seven items and will be used to assess generalized anxiety disorder. At a cut off score of 10 (0-21, 0=No Anxiety Disorder, 21=Severe Anxiety Disorder), it has a sensitivity of 0.89 and specificity of 0.82 for identifying patients with GAD in primary care settings.

Time frame:
Baseline visit and week 10
Reported as:
Mean · score on a scale
Generalized Anxiety Disorder-7 (GAD-7)
score on a scaleTreatment Arm
Baseline7.7 ± 5.6
Week 106.8 ± 5.3
SecondaryAlcohol Use Disorders Identification Test (AUDIT)

Developed by the World Health Organization (WHO), this 10-item screening questionnaire determines harmful or hazardous consumption of alcohol, correctly classifying 95% of people as having a clinical diagnosis of an alcohol abuse disorder (0-12, 0=No Alcohol Use).

Time frame:
Baseline visit and week 10
Reported as:
Mean · score on a scale
Alcohol Use Disorders Identification Test (AUDIT)
score on a scaleTreatment Arm
Baseline2.2 ± 2.8
Week 101.7 ± 1.9
SecondaryPTSD Checklist-Civilian (PCL-C)

This 17-item, self-reported instrument will assess PTSD. A total severity score is determined by summing scores from each of 17 items. A change of 5-10 points represents the minimum threshold for determining treatment response; a 10-20 point change represents a clinically significant change in PTSD symptom severity (17-85, 17=Not at all Severe PTSD Symptoms, 85=Extremely Severe PTSD Symptoms).

Time frame:
Baseline visit and week 10
Reported as:
Mean · score on a scale
PTSD Checklist-Civilian (PCL-C)
score on a scaleTreatment Arm
Baseline40.3 ± 18.1
Week 1040.1 ± 19.3
SecondaryHealing Encounters and Attitudes Lists (HEAL)

HEAL is a validated item-bank comprised of 6 domains developed through the Patient Reported Outcomes Measurement Information System (PROMIS) methodology. Investigators will use HEAL to assess nonspecific factors known to influence patient outcomes, including perceptions of the patient-provider connection, healthcare environment, treatment expectancy, spirituality, positive or negative outlook, and attitudes toward complementary and alternative medicine (CAM). A higher T-score represents more of the concept being measured. A T-score of 50 is equal to the mean and is considered normal. Lower numbers indicate values lower than the mean and higher numbers indicate values higher than the mean. Higher values are indicative of more positive perception. For example, a T-score of 55 on Patient-Provider Connection indicates that the respondent has a more positive perception toward the patient-provider connection than the general chronic condition population (half a standard deviation higher).

Time frame:
After the initial chiropractic visit
Reported as:
Mean · score on a scale
Healing Encounters and Attitudes Lists (HEAL)
score on a scaleTreatment Arm
Patient-Provider Connection - T-Score60.9 ± 10.6
Healthcare Environment - T-Score54.4 ± 8.4
Treatment Expectancy - T-Score54.6 ± 11.5
Positive Outlook - T-Score52.0 ± 10.4
Spirituality - T-Score50.9 ± 13.3
Attitudes toward CAM - T-Score56.0 ± 9.6
SecondaryPain, Enjoyment, and General Activity (PEG)

The PEG is a 3-item tool to improve assessment and monitoring of chronic pain. The overall PEG-3 score ranges from 0-10 with 10 indicating more pain, more interference with enjoyment of life, and more interference with general activity. Questions assess average pain intensity (P) (AVERAGE pain in past week: 0-10, 0= No Pain, 10=Pain as bad as you can imagine), interference with enjoyment of life (E), and interference with general activity (G) (In past week, how pain interfered with...(0-10, 0=Does not interfere, 10=Completely interferes).

Time frame:
Week 3 and Week 7
Reported as:
Mean · score on a scale
Pain, Enjoyment, and General Activity (PEG)
score on a scaleTreatment Arm
Average pain, Week 35.1 ± 2.0
Average pain, Week 74.8 ± 2.0
Enjoyment of Life Pain Interference, Week 35.3 ± 2.2
Enjoyment of Life Pain Interference, Week 74.7 ± 2.5
General Activity Pain Interference, Week 35.2 ± 2.2
General Activity Pain Interference, Week 74.7 ± 2.7
Overall PEG-3 Score, Week 35.2 ± 2.0
Overall PEG-3 Score, Week 74.7 ± 2.3

Adverse events

Collected over Baseline to 10 weeks.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Treatment Arm0/40 (0%)0/40 (0%)5/40 (12.5%)
Most frequent other events
Most frequent other events
EventTreatment Arm
Muscle painMusculoskeletal and connective tissue disorders5/40

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Treatment Arm
<=18 years0
Between 18 and 65 years29
>=65 years11
Age, Continuous
Age, Continuous(years)Treatment Arm
Mean53.3 ± 15.1
Sex: Female, Male
Sex: Female, Male(Participants)Treatment Arm
Female9
Male31
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Treatment Arm
Race — Unknown1
Race — White36
Race — Multi-racial1
Race — Declined to Answer2
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Treatment Arm
Ethnicity — Hispanic or Latino2
Ethnicity — Not Hispanic or Latino38
Region of Enrollment
Region of Enrollment(participants)Treatment Arm
United States40
08

Study locations

4 sites
  • VA Community Based Outpatient Clinic
    Coralville, Iowa 52241, United States
  • Palmer Center for Chiropractic Research
    Davenport, Iowa 52803, United States
  • Iowa City Veterans Affairs Health Care System
    Iowa City, Iowa 52246, United States
  • The Spine Institute for Quality
    Oskaloosa, Iowa 52577, United States
09

References and documents

Publications

  • Lisi AJ, Salsbury SA, Hawk C, Vining RD, Wallace RB, Branson R, Long CR, Burgo-Black AL, Goertz CM. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process. J Manipulative Physiol Ther. 2018 Feb;41(2):137-148. doi: 10.1016/j.jmpt.2017.10.001. PubMed 29482827 ↗
  • Long CR, Salsbury SA, Vining RD, Lisi AJ, Corber L, Twist E, Abrams T, Wallace RB, Goertz CM. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain. Pilot Feasibility Stud. 2022 Mar 7;8(1):54. doi: 10.1186/s40814-022-01008-0. PubMed 35256010 ↗
  • Salsbury SA, Twist E, Wallace RB, Vining RD, Goertz CM, Long CR. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a qualitative study with veteran stakeholders from a pilot trial of multimodal chiropractic care. Pilot Feasibility Stud. 2022 Jan 14;8(1):6. doi: 10.1186/s40814-021-00962-5. PubMed 35031072 ↗

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: No — Feasibility/pilot study

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Feb 2018 to primary completion in Nov 2018, 8 months.

Results were first posted in May 2020, 1 year 6 months after primary completion.

Of 1,231 non-industry interventional studies with no phase under Low Back Pain, half reached primary completion within 11 months of starting (the median), counting those still running; a quarter within 4 and three quarters within 26. This study's 8 months is below that.

Counting every sponsor, half of 1,286 studies reached it within 11 months; a quarter within 5 and three quarters within 27.

How these figures are worked out, and which studies are left out of them.

Registered
Jul 24, 2017
First posted
Aug 18, 2017
StartActual
Feb 19, 2018
Primary completionActual
Nov 5, 2018
CompletionActual
Nov 5, 2018
Results first posted
May 18, 2020
Last update
May 18, 2020
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 18, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03254719
Lead sponsor
Palmer College of Chiropractic
Responsible party
Sponsor
First posted
Aug 18, 2017
Start date
Feb 19, 2018
Primary completion
Nov 5, 2018
Completion
Nov 5, 2018
Results posted
May 18, 2020
Last update
May 18, 2020

Study contacts

Christine M Goertz, DC, PhD
principal investigator · The Spine Institute for Quality
Cynthia Long, PhD
principal investigator · Palmer Center for Chiropractic Research (PCCR)

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in May 2020. You cannot join it, but the record below documents what was studied.

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