What if research could prove doctors of chiropractic are best-suited to lead a multidisciplinary approach to managing low back pain from an effectiveness and cost perspective? The Duke University School of Medicine's Duke Clinical Research Institute (DCRI) is spearheading an exciting new study that puts primary spine practitioners including DCs at the head of a collaborative team approach to improving LBP outcomes.
Christine Goertz, DC, PhD, will serve as DCRI co-principle investigator with Adam Goode, DPT, PhD, joining Jon Lurie, MD, MS, of Dartmouth-Hitchcock Medical Center, to lead the lead the clinical coordinating center for the trial. DCRI's Hrishikesh Chakraborty, DrPH, will lead the data coordinating center.
The patient population will be drawn from 22 family medicine, primary care and general internal medicine clinics in three health care systems – Duke, Dartmouth and the University of Iowa; with plans to enroll 1,800 patients with a primary complaint of LBP. Doctors of chiropractic and physical therapists are considered primary spine practitioners for trial purposes.
A DCRI press release announcing the pragmatic IMPACt-LBP trial noted three primary goals investigators hope to achieve in the course of their research: "To compare the effectiveness of the multidisciplinary/Primary Spine Practitioner (PSP) model compared to usual care; to estimate the cost of implementation of the intervention; and to evaluate barriers and facilitators to implementing a multidisciplinary/PSP care model."
In the DCRI release, Dr. Goertz noted: "Current guidelines call for patients with lower back pain to be treated with non-pharmacological care options first. This study seeks to evaluate guideline-based care by placing patients at the forefront and having a collaborative, multidisciplinary structure in place to support their care."
The National Center for Complementary and Integrative Health is funding the study, with support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute of Child Health and Human Development.
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Dr. Anthony Delitto, dean of the University of Pittsburgh School of Health and Rehabilitation Sciences, has announced that the SHRS will begin offering a Doctor of Chiropractic program in fall 2025, with applications accepted this fall. The program is the first at a research-intensive public university in the U.S. and the only chiropractic program headed by a faculty member with NIH research funding, according to the press release.
While canes, braces and posts represent extrinsic methods for lessening adductor moment arms, an intrinsic method for lessening the development of medial knee osteoarthritis occurs when the hip abductor musculature and the iliotibial band are strong enough to create a compressive force capable of stabilizing the lateral knee.
