CHIROPRACTIC CARE FOR VETERANS
 
   

Chiropractic Care For Veterans

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org
Jump to: Reference Materials Congressional Acts Veterans Research Articles


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Reference Materials
 
   

Chiropractors as the Spinal Health Care Experts
A Chiro.Org article collection

Enjoy these articles about chiropractors as first-contact Spinal Health Care Experts.

Pain Management and Chiropractic
A Chiro.Org article collection

Explore this collection of articles that discusses the relationship between tissue injury and various pyschosocial factors that may contribute towards developing chronic pain.

Chronic Neck Pain and Chiropractic
A Chiro.Org article collection

Review this extensive collection of studies detailing how chiropractic and spinal manipulation are effective for the relief of spinal pain.

Neck and Back Pain in Children and Chiropractic
A Chiro.Org article collection

We hope you will enjoy this extensive collection of articles and studies demonstrating the benefits of chiropractic care for spinal pain in children.

Radiculopathy and Chiropractic Page
A Chiro.Org article collection

We hope you will enjoy this extensive collection of articles and studies demonstrating the benefits of chiropractic care for radiculopathy.

Low Back Pain and Chiropractic
A Chiro.Org article collection

Ditto.

The Biopsychosocial Model
A Chiro.Org article collection

The late George Engel believed that to understand and respond adequately to patients’ suffering — and to give them a sense of being understood — clinicians must attend simultaneously to the biological, psychological, and social dimensions of illness. He offered a holistic alternative to the prevailing biomedical model that had dominated industrialized societies since the mid-20th century. [1] His new model came to be known as the biopsychosocial model.

Clinical Prediction Rules
A Chiro.Org article collection

Recently, Flynn and colleagues [17] developed a clinical prediction rule for identifying patients with low back pain who are likely to benefit from manipulation. They examined a series of patients with low back pain who received a manipulation intervention. Five factors formed the most parsimonious set of predictors for identifying patients who achieved at least 50% improvement in disability within 1 week with a maximum of 2 manipulation interventions (Table 1) [17]. The positive likelihood ratio among patients who met at least 4 of 5 of the criteria was 24.4 (95% CI, 4.6 to 139.4).

Integrated Health Care and Chiropractic
A Chiro.Org article collection

This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. Doctors of chiropractic that are integrated within military and veteran health care facilities manage common neurological, musculoskeletal, and other conditions; severe injuries obtained in combat; complex cases; and cases that include psychosocial factors. Chiropractors collaboratively manage patients with other providers and focus on reducing morbidity for veterans and rehabilitating military service members to full duty status. Patient satisfaction with chiropractic services is high. Preliminary findings show that chiropractic management of common conditions shows significant improvement.

The Prescription Rights and Expanded Practice Debate
A Chiro.Org article collection

There is a growing desire within [a very small percentage of the] chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine/ musculoskeletal disorders.

 
   

Congressional Acts
 
   

Public Law 106–117 — November 30, 1999
Veterans Millennium Health Care and Benefits Act

106th Congress ~ FULL TEXT
To amend title 38, United States Code, to establish a program of extended care services for veterans, to make other improvements in health care programs of the Department of Veterans Affairs, to enhance compensation, memorial affairs, and housing programs of the Department of Veterans Affairs, to improve retirement authorities applicable to judges of the United States Court of Appeals for Veterans Claims, and for other purposes.

Public Law 107–135 — January 23, 2002
Department of Veterans Affairs Health Care Programs Enhancement Act of 2001

107th Congress ~ FULL TEXT
To amend title 38, United States Code, to enhance the authority of the Secretary of Veterans Affairs to recruit and retain qualified nurses for the Veterans Health Administration, to provide an additional basis for establishing the inability of veterans to defray expenses of necessary medical care, to enhance certain health care programs of the Department of Veterans Affairs, and for other purposes.

Chiropractic Services in the Department of Veterans Affairs
Hearing before the Subcommittee on Health of the Committee on Veterans Affairs.
House of Representatives, One Hundred Sixth Congress,
Second Session. October 3, 2000. ~ FULL TEXT

Fact Sheet for Veteran's Chiropractic Services
Department of Veterans Affairs 2005 ~ FULL TEXT
In response to Veteran demand, Congress authorized VA to begin providing chiropractic services in 1999. Since late 2004, chiropractic services have been included as part of the standard Medical Benefits Package available to all enrolled Veterans. VA provides these services on-station or by fee-basis at all medical centers.

 
   

Veterans Articles & Research
 
   

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
for Acute Low Back Pain: Systematic Review and Meta-analysis

JAMA. 2017 (Apr 11);   317 (14):   1451–1460 ~ FULL TEXT

Of 26 eligible RCTs identified, 15 RCTs (1,711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, -9.95 [95% CI, -15.6 to -4.3]). Twelve RCTs (1,381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, -0.39 [95% CI, -0.71 to -0.07]). Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT.

The Effect of Chiropractic Treatment on the Reaction and Response Times
of Special Operation Forces Military Personnel: Study Protocol
for a Randomized Controlled Trial

Trials. 2016 (Sep 20);   17 (1):   457 ~ FULL TEXT

U.S. military special operation forces' (SOF) personnel are highly motivated and extremely physically fit individuals whose occupation requires reaction times that are as quick as possible during the course of their assigned duties. A goal of CMT is to maximize the functionality and integration of the neuromusculoskeletal systems. Therefore, chiropractic treatment may be able to optimize the capacity of the numerous components of those systems, resulting in improved reaction time. The objective of this study is to test the hypothesis that CMT improves reaction and response times in asymptomatic SOF personnel.

Trends in the Use and Characteristics of Chiropractic Services
in the Department of Veterans Affairs

J Manipulative Physiol Ther. 2016 (Jun);   39 (5):  381–386 ~ FULL TEXT

Since their introduction more a decade ago, use of on-station chiropractic services in VA, the VA chiropractic workforce, and VA’s use of purchased chiropractic care have grown substantially. The types of conditions for which patients see VA chiropractors and the types of services they receive are similar to previous reports of chiropractic care in the United States. Because VA continues to expand its delivery of chiropractic care, ongoing work is needed to assess the delivery of these services so that they can be optimized to provide the most value to Veterans and the VA health care system.

Integration of Chiropractic Services in Military and Veteran
Health Care Facilities: A Systematic Review of the Literature

J Evid Based Complementary Altern Med. 2016 (Apr);   21 (2):   115–130

This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility.

Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel
With Low Back Pain: Study Protocol for a Randomized Controlled Trial

Trials. 2016 (Feb 9); 17: 70 ~ FULL TEXT

Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability.

Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans:
A Prospective, Randomized, Placebo-Controlled Trial

Geriatr Orthop Surg Rehabil. 2014 (Dec);   5 (4):   154–164 ~ FULL TEXT

This is an interesting, but disappointing study. On a quick read-through, it appears to suggest that chiropractic adjusting (spinal manipulative therapy, or SMT) is no more effective than a placebo. My first reaction (OH NO!) was that this is just another study to fall into the black hole of previous placebo studies, in which both groups improved (and in this case, SMT did fare slightly better) but are difficult to distinguish between groups at 12-weeks. (8-weeks after the care had ended).

On closer examination, the actual breakdown of treatment was: Of the 69 patients randomized to the SMT group,

19   (28%)   underwent HVLA spinal manipulation,
57   (83%)   underwent flexion distraction, and
29   (42%)   underwent mobilization.
A-Ha! So, LESS THAN 13 of these patients actually received SMT, while one-half of then received mobilization.   That means that this paper should have concluded that mobilization (or flexion distraction) of the spine appears to be no more effective than placebo.

Variations in the Implementation and Characteristics of
Chiropractic Services in VA

Medical Care 2014 (Dec);   52 (12 Suppl 5):   S97–104 ~ FULL TEXT

Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

Evaluation of a Modified Clinical Prediction Rule For Use With Spinal
Manipulative Therapy in Patients With Chronic Low Back Pain:
A Randomized Clinical Trial

Chiropractic & Manual Therapies 2014 (Nov 18);   22 (1):   41 ~ FULL TEXT

Recent literature has highlighted the lack of definitive data to emerge from RCTs evaluating Chronic Lower Back Pain (CLBP), with no treatment producing consistently superior outcomes. [29-32] In keeping with this previous literature and supporting our first hypothesis, we found clinically and statistically significant improvements in outcomes from baseline to follow up in the groups receiving Spinal Manipulative Therapy (SMT) and Active Exercise Therapy (AET), which are both recognized as evidence based interventions for CLBP. [10, 31]

Impact of Chiropractic Services at an On-Site Health Center
J Occup Environ Med. 2014 (Sep);   56 (9):   990–992

There were 876 on-site and 759 off-site participants. The off-site group received more radiology services overall (55.5% vs 38.2%; P < 0.001) including magnetic resonance imaging, ultrasound, and radiograph (all P < 0.0001); had higher outpatient (P < 0.0001) and emergency department (P = 0.022) utilization; and demonstrated greater use of chiropractic care and physical therapy (both P < 0.0001).   Compared with off-site care, on-site chiropractic services are associated with lower health care utilization. These results support the value of chiropractic services offered at on-site

Mixed-Methods Research in a Complex Multisite VA Health Services Study:
Variations in the Implementation and Characteristics
of Chiropractic Services in VA

Evid Based Complement Alternat Med. 2013 (Dec 31);   701280 ~ FULL TEXT

Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs' healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches-insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS). Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources.

Adding Chiropractic Manipulative Therapy to Standard Medical Care
for Patients with Acute Low Back Pain: Results of a Pragmatic
Randomized Comparative Effectiveness Study

Spine (Phila Pa 1976). 2013 (Apr 15);   38 (8):   627–634

The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.

Chiropractic Management of a US Army Veteran With Low Back Pain
and Piriformis Syndrome Complicated by an Anatomical
Anomaly of the Piriformis Muscle: A Case Study

Journal of Chiropractic Medicine 2012 (Mar);   11 (1):   24–29 ~ FULL TEXT

Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation.   A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.

Retrospective Case Series of Clinical Outcomes Associated With Chiropractic
Management for Veterans With Low Back Pain

J Rehabil Res Dev. 2011;   48 (8):   927–934 ~ FULL TEXT

The clinical outcomes achieved for this sample should be considered within the context of this veteran patient base, which is typically represented by older, white males with multiple comorbidities. A high percentage of overall service-connected disability was noted, with only a small percentage associated with the low back region. Considerable psychological comorbidity was found, with a high prevalence of PTSD and depression diagnoses. PTSD and chronic pain tend to co-occur and may interact in a way that can negatively affect either disorder. [21-23] A previous retrospective study of chiropractic management for neck and back pain demonstrated less improvement among those with PTSD. [11] These points are significant because severe comorbidities and psychosocial factors lessen the likelihood of obtaining positive outcomes with conservative measures, including SMT, for chronic LBP. [6] Mean percentages of clinical improvement exceeded the MCID, despite the levels of service-connected disability and comorbidity among this sample of veteran patients.

Complementary and Alternative Medicine Use Among Veterans
With Chronic Noncancer Pain

J Rehabil Res Dev. 2011;   48 (9):   1119–1128 ~ FULL TEXT

We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture.

Conservative Management of Uncomplicated Mechanical Neck Pain
in a Military Aviator

J Can Chiropr Assoc. 2010 (Jun);   54 (2):   92–99 ~ FULL TEXT

Neck pain is highly prevalent in fighter jet aviators and can compromise mission safety and aviator function. [3, 8] Chronic neck pain and some medications may be considered disqualifying for flight for military pilots according to the US Navy Aeromedical Reference and Waiver Guide. Manual therapy and therapeutic exercise are recommended for treating this problem and are not considered disqualifying. Therefore, applying these conservative options that help with managing pain and function for aviators could be considered. In this case, a pilot with neck pain was managed following these recommendations and was able to successfully continue flying without return of pain or dysfunction.

Management of Operation Iraqi Freedom and Operation Enduring Freedom
Veterans in a Veterans Health Administration Chiropractic Clinic:
A Case Series

J Rehabil Res Dev. 2010;   47 (1):   1–6 ~ FULL TEXT

Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans commonly seek care for musculoskeletal complaints in Veterans Health Administration (VHA) facilities. Chiropractic services for musculoskeletal conditions have recently been introduced to VHA. No reports have been published on chiropractic care for OIF/OEF veterans. This study was designed to describe elements of the processes and outcomes of care for OIF/OEF veterans in a VHA chiropractic clinic. A retrospective review of consecutive cases consulted to one VHA chiropractic clinic was conducted. Thirty-one cases were identified. Consultations originated in primary care and specialty clinics that commonly manage musculoskeletal conditions.

Integrated Musculoskeletal Rehabilitation Care at a Comprehensive Combat
and Complex Casualty Care Program

J Manipulative Physiol Ther. 2009 (Nov);   32 (9):   781–791 ~ FULL TEXT

After construction of the facility in 2007, the program has provided services for approximately 2 years. Eighteen different health care providers from 10 different specialties provide integrated musculoskeletal services, which include primary care, physical therapy, occupational therapy, vestibular therapy, gait analysis, prosthetics, recreational therapy, and chiropractic care. At the time of this writing (early 2009), the program had provided musculoskeletal rehabilitation care to approximately 500 patients, 58 with amputations, from the operational theater, Veterans Affairs, other military treatment facilities, and local trauma centers.

An Analysis of the Integration of Chiropractic Services Within the
United States Military and Veterans' Health Care Systems

J Manipulative Physiol Ther. 2009 (Nov);   32 (9):   749–757 ~ FULL TEXT

We identified 9 areas wherein potential opportunities and threats to integration existed, including legislative history, programmatic growth, leadership structure, employment status of providers, clinical work duties, patient access, patient demographics, academic affiliations, and research.   These findings provide a higher level of understanding regarding the current state and future direction of chiropractic service integration within these integrated health care systems.

Chiropractic Practice in Military and Veterans Health Care:
The State of the Literature

J Can Chiropr Assoc. 2009 (Aug);   53 (3):   194–204 ~ FULL TEXT

Chiropractic services seem to be included successfully within military and veteran health care facilities. However, there is a great need for additional written evaluation of the processes, policies, practices, and effectiveness of chiropractic services in these environments.

A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care
in Veterans With and Without Post-traumatic Stress Disorder

Military Medicine 2009 (Jun);   174 (6):   578–583 ~ FULL TEXT

This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability.


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