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North American Spine Society (NASS): Best Paper Award 2019

Updated: Apr 9, 2019

Congratulations, Dr. Arthur and colleagues on your 2019 North American Spine Society: Best Paper Award!

The research paper entitled: "Chiropractors treating patients with acute lower back pain in a spine treatment pathway model: A five year prospective cohort study" will be presented at The NASS 34th Annual Meeting held at McCormick Place West, Chicago, IL September 25th-28th, 2019.


Background Context: Patient access to current best evidence primary care treatment for acute lower back remains highly problematic (1). Treatment pathway models have the potential to improve patient access to care, provide seamless transitions from one form of treatment to another, optimize clinical outcomes, improve cost effectiveness and reduce progression to chronic illness/pain (2). A standardized protocol of hospital-based outpatient clinic chiropractic lumbar spinal manipulative therapy (CSMT) as a component of care for patients with acute lower back pain (ALBP) has been previously validated (3).

Purpose: To determine the feasibility and patient satisfaction of a community-based standardized chiropractic treatment protocol as a component of primary care spine treatment pathway in the treatment of patients with ALBP.

Study Design/Setting: Feasibility prospective cohort study.

Patient Sample: Inclusion: Patients with ALBP without radiculopathy of less than 24 weeks duration; Exclusion: Red flag conditions; SPECT scan positive facet arthropathy; ≥ Grade IV Thompson lumbar disc degeneration at one or more levels; relevant DSM 5 diagnoses; third party insurer involvement.

Outcome Measures: Willingness to participate of ALBP patients and community chiropractors. Rate of compliance with standardized treatment protocol in community-based chiropractors. Patient wait times, satisfaction scores, pre and post VAS and ODI scores, need for additional imaging, rate of discharge from hospital outpatient clinic.

Methods: Community-based chiropractors from three British Columbia Provincial Health Regions agreed to accept referrals from a hospital-supervised primary care spine program to treat ALBP patients with standardized protocol comprised of a maximum four week course of lumbar spine-only CSMT and a lumbar spine flexibility instruction exercise program. Participating patients were seen for follow-up in the hospital spine outpatient clinic at four and eight weeks post treatment.

Results: Over the five year duration of the study, 368/380 (97%) of eligible patients and 21/26 (81%) of community-based chiropractors agreed to participate. 17/21 chiropractors (81%) consistently administered treatment within the boundaries of the standardized research study protocol. VAS and ODI scores improved significantly in 320/368 (87%) patients. The average wait times for access to treatment was 7.4 days. 82% of patients reported high satisfaction scores. The rate of required additional diagnostic imaging was 3%. Rates of discharge from the hospital spine program outpatient clinic with no requested follow-up by six months was 86%.

Conclusions: A standardized protocol of CSMT and flexibility exercise instruction administered by community-based chiropractors to a specific cohort of patients with ALBP is a feasible component of a primary care spine treatment pathway.



1. Buchinder R, van Tulder M, Olberg B, et al. Low Back Pain: a call for action. Lancet 31:10137, 2384-2388 June 2018

2. College of Family Physicians of Canada. care networks.

3. Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: A randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J 2010 Outstanding Paper Award; 10:1055-64.


Authors: Paul B. Bishop, MD, PhD, DC, Jeffrey A. Quon, PhD, DC, Bradley W. Yee, DC, Brian E. Arthur, DC, MSc, Pauline G. Fedder, DC, Jennifer C. Forbes, DC, MS, Eugene Lee, DC5, Arthur A. Lopes, DC, Anne M. Maylin-Lee, DC, Elli P. Morton, DC, BS, Michael J. Vipond, DC, Clodagh McDonnell, MSc.

Affiliations: Division of Spine, Department of Orthopaedic Surgery University of British Columbia, International Collaboration on Repair Discoveries (ICORD); School of Population and Public Health, University of British Columbia; Community-based chiropractor


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