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SUMMARYBackgroundChronic low back pain (cLBP) affects the quality of life of 52 million Americans and leads to an enormous personal and economic burden. A multidisciplinary approach to cLBP management is recommended. Since medication has limited efficacy and there are mounting concerns about opioid addiction, the American College of Physicians and American Pain Society recommend non-pharmacological interventions, such as mind and body approaches (e.g., Qigong, yoga, Tai Chi) before prescribing medications. Of those, Qigong practice might be most accessible given its gentle movements and because it can be performed standing, sitting, or lying down. The three available Qigong studies in adults with cLBP showed that Qigong reduced pain more than waitlist and equally well than exercise. Yet, the duration and/or frequency of Qigong practice were low (MethodsWe conducted a feasibility Phase I Randomized Clinical Trial. Of the 36 adults with cLBP recruited between January 2020 and June 2021, 32 were enrolled and randomized to either 12 weeks of remote Spring Forest Qigong™ practice or remote P.Volve low-intensity exercises. Participants practiced at least 3x/week for 41min/session with online videos. Our main outcome measures were the Numeric Pain Rating Scale (highest, average, and lowest cLBP pain intensity levels in the prior week), assessed weekly and fMRI data (resting-state and task-based fMRI tasks: pain imagery, kinesthetic imagery of a Qigong movement, and robot-guided shape discrimination). We compared baseline resting-state connectivity and brain activation during fMRI tasks in adults with cLBP with data from a healthy control group (n=28) acquired in a prior study. Secondary outcomes included measures of function, disability, body awareness, kinesiophobia, balance, self-efficacy, core muscle strength, and ankle proprioceptive acuity with a custom-build device.ResultsFeasibility of the study design and methods was demonstrated with 30 participants completing the study (94% retention) and reporting high satisfaction with the programs; 96% adherence to P.Volve low-intensity exercises, and 128% of the required practice intensity for Spring Forest Qigong™ practice. Both groups saw promising reductions in low back pain (effect sizes Cohen’sd=1.01-2.22) and in most other outcomes (d=0.90-2.33). Markers of ankle proprioception were not significantly elevated in the cLBP group after the interventions. Brain imaging analysis showed weaker parietal operculum and insula network connectivity in adults with cLBP (n=26), compared to data from a healthy control group (n=28). The pain imagery task elicited lower brain activation of insula, parietal operculum, angular gyrus and supramarginal gyrus at baseline in adults with cLBP than in healthy adults. Adults with cLBP had lower precentral gyrus activation than healthy adults for the Qigong movement and robot task at baseline. Pre-post brain function changes showed individual variability: Six (out of 13) participants in the Qigong group showed increased activation in the parietal operculum, angular gyrus, supramarginal gyrus, and precentral gyrus during the Qigong fMRI task.InterpretationOur data indicate the feasibility and acceptability of using Spring Forest Qigong™ practice or P.Volve low-intensity exercises for cLBP relief showing promising results in terms of pain relief and associated symptoms. Our brain imaging results indicated brain function improvements after 12 weeks of Qigong practice in some participants, pointing to the need for further investigation in larger studies.Trial registration numberClinicalTrials.gov:NCT04164225.

Refereed/Peer-reviewed Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers’ decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.

Background Mindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers. Objectives This study will test two approaches to delivering MBIs for improving Veterans’ chronic pain and mental health comorbidities. These two approaches address key implementation barriers. Methods We will conduct a four-site, three-arm pragmatic randomized controlled trial, Learning to Apply Mindfulness to Pain (LAMP), to test the effectiveness of two MBIs at improving pain and mental health comorbidities. Mobile+Group LAMP consists of prerecorded modules presented by a mindfulness instructor that are viewed in an online group setting and interspersed with discussions led by a facilitator. Mobile LAMP consists of the same prerecorded modules but does not include a group component. We will test whether either of these MBIs will be more effective than usual care at improving chronic pain and whether the Mobile+Group LAMP will be more effective than Mobile LAMP at improving chronic pain. Comparisons for the primary hypotheses will be conducted with continuous outcomes (Brief Pain Inventory interference score) repeated at 10 weeks, 6 months, and 12 months. The secondary hypotheses are that Mobile+Group LAMP and Mobile LAMP will be more effective than usual care at improving secondary outcomes (e.g., post-traumatic stress disorder, depression). We will also confirm the comparisons for the primary and secondary hypotheses in gender-specific strata. Implications This trial is expected to result in two approaches for delivering MBIs that will optimize engagement, adherence, and sustainability and be able to reach large numbers of Veterans.

Addressing teachers’ ability to better navigate stress and emotional responses has the potential to improve classroom behaviors, student learning as well as teachers’ wellbeing. While there is growing interest in mindfulness-based interventions (MBIs), there is need for greater attention to design aligned with relevant theories and transparent reporting to improve the rigor and translation of research. While utilized widely in health and behavior fields, behavior change theory has not been applied extensively in education or MBI research. This descriptive methodological paper articulates the intervention mapping and design process of an MBI to improve teachers’ stress and emotional regulation. To improve reporting, we use a post hoc application of a well-established behavioral model. Application of the Behavior Change Wheel (BCW) as part of an intervention mapping approach for an MBI to align teacher’s needs with intervention elements most likely to achieve desired behavioral outcomes. The paper illustrates an approach which includes defining the problem in behavioral terms, identification of target behaviors and behavioral change techniques, and selection of strategies and modes of intervention delivery. A systematic intervention mapping approach applying the BCW can yield a holistic MBI for the desired behavior change, enhanced emotion and stress regulation in teachers. This example of applying the BCW to the design of an MBI demonstrates how intervention designers and researchers can make decisions about which techniques and delivery components to include in their interventions, and how to systematically describe them. Such approaches have the potential to improve the reporting and methodological rigor of future MBI research and the successful application of interventions in practice.

Author(s): Roseen, Eric J; Kasali, Bolanle Aishat; Corcoran, Kelsey; Masselli, Kelsey; Laird, Lance; Saper, Robert B; Alford, Daniel P; Cohen, Ezra; Lisi, Anthony; Atlas, Steven J; Bean, Jonathan F; Evans, Roni; Bussieres, Andre | Abstract: IntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within integrated healthcare delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improving collaboration between medical providers and community-based DCs, or embedding DCs in medical settings such as hospitals or community health centres, will improve access to evidence-based care for musculoskeletal conditions.Methods and analysesThis scoping review will map studies of DCs working with or within integrated healthcare delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (eg, shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention, implementation strategies and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based survey.Ethics and disseminationEthics approval will not be obtained for this review of published and publicly accessible data, but will be obtained for the web-based survey. Our results will be disseminated through conference presentations and a peer-reviewed publication. Our findings will inform implementation strategies that support the adoption of chiropractic care within integrated healthcare delivery systems.

BackgroundBetween 2013-2018 Pacific College of Health and Science (formerly Pacific College of Oriental Medicine) trained faculty and developed curriculum in evidence informed practice (EIP), with support from a grant from the National Institutes of Health (NIH). A three-credit (45 hour) Foundations of EIP course, and online EIP learning modules (developed as part of a previous NIH R25 award), were used for faculty and student training. In addition, EIP was incorporated into 73% of the East Asian medicine degree program. Clinical integration of EIP in the College clinic was enhanced by improving access to reference sources, including additional EIP-related questions to the patient intake forms, requiring the use of a patient-centered outcome instrument, and assessing student’s clinical EIP competencies. MethodsMaster’s degree student’s EIP skills, knowledge, attitudes and behaviors were assessed before and after taking the Foundations of EIP course using a 17-question paper-based survey with an additional open-ended comments section. The survey was administered in 29 courses across all three Pacific College campuses. Clinical faculty EIP instruction was evaluated on the New York City campus using a paper-based survey before and after changes were made to enhance the clinical integration of EIP. ResultsA total of 1181 completed EIP-course surveys consisting of 657 pre-EIP course surveys and 524 post-EIP course surveys were analyzed. There was a statistically significant improvement in student’s EIP skills, knowledge and behaviors after completing the EIP course. Students’ perception of the importance of EIP was high before and after the EIP course. Little change in Faculty’s EIP-related clinical instruction was evident following the EIP-related changes that were made to the Clinic. Conclusion Students’ self-assessed EIP skills, knowledge and behaviors improved after EIP training. Different approaches may be required to improve implementation of EIP in clinical settings.

IntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide nonpharmacologic treatment aligned with international clinical practice guidelines. Although DCs practice in at least 90 countries, chiropractic care is often not available within integrated health care delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improved collaboration between medical providers and community-based DCs, or embedding DCs in medical settings such as hospitals or community health centers, will improve access to evidence-based care for musculoskeletal conditions.Methods and analysesThis scoping review will map studies of DCs working with or within integrated health care delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase, and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (e.g., shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention; implementation strategies; and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based survey.Ethics and disseminationEthics approval will not be obtained for this review of published and publicly accessible data. Our results will be disseminated through conference presentations and a peer-reviewed publication. Our findings will inform implementation strategies that support the adoption of chiropractic care within integrated health care delivery systems.Strengths and limitations of this studyThis scoping review will be among the first to comprehensively map literature of doctors of chiropractic (DCs) working with or within military, veteran or civil integrated health care delivery systems.The literature search strategy is comprehensive and potentially generalizable to a global DC workforce, and relevant to other nonpharmacologic therapy providers who typically work in the community, e.g., acupuncturists, psychologists.A multidisciplinary team with diverse clinical and research expertise will inform our scoping review across all stages of the work.We have organized our search strategy and extraction form/guide around standardized terminology from the field of implementation science. It may be challenging to identify relevant studies, or extract all useful information, if original research does not use this terminology.Non-English articles describing the implementation of chiropractic care in a medical setting may be missed.

Objectives: To train faculty and develop curricula in evidence-informed practice (EIP) within a Chinese medicine degree program. Setting: Pacific College of Oriental Medicine (New York). Design: Faculty EIP training was undertaken through utilization of online EIP modules, and development and completion of a 3-credit (45 h) online Foundations of EIP course. This was supplemented by faculty meetings and one-on-one support from department chairs. Curriculum development was undertaken by an EIP Curriculum Committee. The committee followed a modified Delphi process to develop EIP course learning outcomes (CLOs), and to make changes to the College's clinic policies and procedures. EIP assignments were developed for each course in accordance with the CLO. Results: Ninety-one percent of the faculty and 97% of clinical supervisors received formal EIP training. Thirty-five percent of all didactic faculty, 38% of faculty teaching courses with EIP incorporated, and 30% of clinical supervisors completed 10 or more h of EIP training during this project. Faculty also received informal EIP training through participation in department and general faculty meetings. Seventy-three percent of the Master's degree curriculum, inclusive of 40 didactic courses and fifteen 60-h clinic shifts, were modified to incorporate EIP. EIP CLOs and corresponding assignments were developed. Clinic intake forms were modified to facilitate undertaking EIP in the College clinic. Issues related to how EIP is defined in conjunction with the nature of available scientific research in Chinese medicine required discussion and resolution. Conclusions: Training faculty and developing curricula in EIP within Chinese medicine colleges has unique challenges that must be factored into the strategies and processes. Factors that contributed to the success of this project were having faculty drive the process, integrating EIP content within existing curricula, gradual exposure, identifying champions, relating EIP to practice building, and openly discussing opposing perspectives.

Expressive writing has been shown to improve physical, mental, and social health outcomes for patients struggling with difficult diagnoses. In many online health communities, writing comprises a substantial portion of the user experience, yet little work has explored how writing itself affects user engagement. This paper explores user engagement on CaringBridge, a prominent online community for writing about personal health journeys. We build a survival analysis model, defining a new set of variables that operationalize expressive writing, and comparing these effects to those of social support, which are well-known to benefit user engagement. Furthermore, we use machine learning methods to estimate that approximately one third of community members who self-identify with a cancer condition cease engagement due to literal death. Finally, we provide quantitative evidence that: (1) receiving support, expressive writing, and giving support, in decreasing magnitude of relative impact, are associated with user engagement on CaringBridge, and (2) that considering deceased sites separately in our analysis significantly shifts our interpretations of user behavior.

Background Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life. Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear. Methods We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP. Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks. The primary outcome was pain severity. Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement. Linear mixed models were used to analyze outcomes. The primary analysis included longitudinal outcomes in the short (week 4–12) and long-term (week 4–52). An omnibus test assessing differences across all groups over the year was used to control for multiplicity. Secondary analyses included outcomes at each time point and responder analyses. This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Results 241 participants were randomized and 230 (95%) provided complete primary outcome data. The primary analysis showed group differences in pain over the one-year were small and not statistically significant. Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone. Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment. One-year post-treatment pain reductions diminished in all three groups. Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone. Conclusions Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care. Trial registration NCT00269321.

Objectives: The combination of biomedicine and traditional and complementary medicine (T&CM) is often referred to as integrative medicine. However, the degree to which the medical disciplines are integrated varies between medical settings, and it is believed by some to be impossible due to epistemological and paradigmatic differences. Clinicians' perspectives are important determinants of how different medical disciplines are used together. This study explores the perspectives of experienced Chinese medicine practitioners when asked about the most ethical model (opposition, integration, or pluralism) for the relationship between biomedicine and T&CM. Design: Thirty-one Chinese medicine practitioners, undertaking a doctoral upgrade program at the Pacific College of Oriental Medicine, participated in this study. Participants were asked to read a publication discussing three models (opposition, integration, and pluralism) for the relationship between biomedicine and T&CM and then discuss, via an online forum within Moodle learning management system, the most ethical model. An inductive content analysis of the forum posts was undertaken to identify common themes, followed by member checking. Results: The data were found to contain six major and six minor themes. There was a clear preference for pluralism. The Chinese medicine practitioners expressed reservations about the integrative model, and, above all, cared about the quality of patient care. Much dialogue occurred around issues related to a power imbalance within health care, and possible cooptation issues. Paradigmatic differences and a lack of compatibility between biomedical research models and the practice of Chinese medicine were seen as problematic to the validity of research findings. Interprofessional education was viewed as critical for the development of respect, shared patient care, and referrals between clinicians from different disciplines. Conclusions: This study provides insight into the issues associated with combining biomedicine and T&CM that are perceived by Chinese medicine practitioners. Such insights are important for the development and management of clinical settings that provide complementary and integrative health care, especially as the provision of insurance coverage for T&CM increases.

CaringBridge (CB) is a web-based social network where people share information, enlist support, and access resources following a difficult diagnosis; it can also be used to disseminate supportive self-care tools, such as a gratitude practice, for its users. Gratitude practices are shown to reduce stress and fear, improve sleep, and increase positive emotions and overall well-being. The purpose of this article was to report the findings of a brief gratitude intervention delivered to CB users. Design, setting/location, subjects: This is a nonrandomized, prospective, pre- and post-evaluation study in an online community. Inclusion criteria were adults 18 years or older, English literate, willingness to participate in a mind-body practice, and active users of CB: patient, caregiver, or visitor to a site.Participants were engaged in a daily, 21-day brief gratitude practice and were given weekly automated reminders to do their practice.Outcomes included perceived stress, gratitude, social connectedness, and social assurance scales. Paired t tests were used to assess changes in outcomes; multivariate regression models were used to assess the relationship between the frequency of gratitude practice and change in outcomes.Follow-up data were collected from 882/1598 participants, and nearly 70% self-reported engaging in the gratitude practice five or more days/week. Participants reported statistically significant improvement in all outcomes with small standardized effect sizes for gratitude (0.39), social connectedness (0.24), and social assurance (0.10). Changes in perceived stress (-0.73) were larger in magnitude and increased with more frequent practice.Among this online community, there was a high level of engagement with a brief gratitude practice, and improvements in stress, gratitude, and social support were observed. This design did not control for changes in outcomes that may be due to time trends, placebo or contextual effects, regression to the mean, or selection bias.

Objectives: To examine the prevalence of complementary and alternative medicine (CAM) use by race/ethnicity and to identify sociodemographic and health-related factors associated with CAM use among US adults with moderate mental distress (MMD). Methods: We analyzed data from the 2012 National Health Interview Survey (NHIS). We used data for 6016 noninstitutionalized US adults with MMD (3492 non-Hispanic whites, 953 non-Hispanic blacks, 1078 Hispanics, 268 Asians, and 225 others consisted of American Indian, Alaska Native, and those reporting multiple races). The 2012 NHIS asks about 36 types of CAM use in the past 12 months. We constructed (1) overall, any CAM use; (2) 5 major types of CAM use; and (3) individual types of CAM use indicators. Using a cross-sectional design with complex survey techniques, we estimated race/ethnicity-specific CAM prevalence, and odds of past year CAM use by race/ethnicity, sociodemographic, and health-related factors. Results: Nearly 40% of adults with MMD used CAM in the past year compared with 32% of those without MMD ( P < .001). In adults with MMD, past year CAM use differed by race/ethnicity, ranging from 24.3% (blacks) to 44.7% (Asians) and 46.8% (others) ( P < .001). Being younger, female, living in the west, higher education, being employed, more than 4 ambulatory care visits, and functional limitations were associated with higher odds of CAM use ( P < .01). Conclusions: Adults with MMD use CAM more frequently than those without MMD. In addition, CAM use was significantly differed by race/ethnicity in adults with MMD. This underscores the need for good patient-provider communication and suggests opportunity for dialogue about integration between conventional providers and CAM practitioners to facilitate optimal mental health care.

Complementary and integrative healthcare (CIH) is commonly used to treat low back pain (LBP). While the use of CIH within hospitals is increasing, little is known regarding the delivery of these services within inpatient settings. We examine the patterns of CIH services among inpatients with mechanical LBP in a hospital setting.This is a retrospective, practice-based study conducted at Abbot Northwestern hospital in Minnesota. Using electronic health record data from July 2009 to December 2012, 8095 inpatients with mechanical LBP were identified using ICD-9 codes. We classified patients by reason for hospitalization. We examined demographic and clinical characteristics by receipt of CIH services. Then, we estimated the prevalence of types of CIH delivered and clinical foci for CIH visits among inpatients with mechanical LBP.Most inpatients with mechanical LBP (90%) were hospitalized for surgical procedures. Overall, 14.2% received inpatient CIH services. All demographic and clinical characteristics differed by receipt of CIH (P0.001), except race/ethnicity. CIH recipients were in poorer health than those who did not. Most commonly delivered CIH services were massage (62.1%), relaxation techniques (42.0%) and acupuncture (25.7%). Pain (45.1%), relaxation (17.5%), and comfort (8.2%) were the top three reasons for CIH visits.There are important differences between CIH recipients and non-CIH recipients among patients with mechanical LBP within a hospital setting. The reasons documented for CIH visits included addressing physical, emotional and/or mental conditions of patients. Future studies are needed to determine the effectiveness of CIH services health and wellbeing outcomes in this population.

Background Spinal pain is a common and disabling condition with considerable socioeconomic burden. Spine pain management in the United States has gathered increased scrutiny amidst concerns of overutilization of costly and potentially harmful interventions and diagnostic tests. Conservative interventions such as spinal manipulation, exercise and self-management may provide value for the care of spinal pain, but little is known regarding the cost-effectiveness of these interventions in the U.S. Our primary objective for this project is to estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management for spinal pain using an individual patient data meta-analysis approach. Methods/design We will estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management using cost and clinical outcome data collected in eight randomized clinical trials performed in the U.S. Cost-effectiveness will be assessed from both societal and healthcare perspectives using QALYs, pain intensity, and disability as effectiveness measures. The eight randomized clinical trials used similar methods and included different combinations of spinal manipulation, exercise therapy, or self-management for spinal pain. They also collected similar clinical outcome, healthcare utilization, and work productivity data. A two-stage approach to individual patient data meta-analysis will be conducted. Discussion This project capitalizes on a unique opportunity to combine clinical and economic data collected in a several clinical trials that used similar methods. The findings will provide important information on the value of spinal manipulation, exercise therapy, and self-management for spinal pain management in the U.S.

Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity. Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0-10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.

Background: Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS. Methods: Mixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention. Results: Participants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support. Conclusion: SMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns.

Online educational interventions to teach evidence-based practice (EBP) are a promising mechanism for overcoming some of the barriers to incorporating research into practice. However, attention must be paid to aligning strategies with adult learning theories to achieve optimal outcomes.We describe the development of a series of short self-study modules, each covering a small set of learning objectives. Our approach, informed by design-based research (DBR), involved 6 phases: analysis, design, design evaluation, redesign, development/implementation, and evaluation. Participants were faculty and students in 3 health programs at a complementary and integrative educational institution.We chose a reusable learning object approach that allowed us to apply 4 main learning theories: events of instruction, cognitive load, dual processing, and ARCS (attention, relevance, confidence, satisfaction). A formative design evaluation suggested that the identified theories and instructional approaches were likely to facilitate learning and motivation. Summative evaluation was based on a student survey (N=116) that addressed how these theories supported learning. Results suggest that, overall, the selected theories helped students learn.The DBR approach allowed us to evaluate the specific intervention and theories for general applicability. This process also helped us define and document the intervention at a level of detail that covers almost all the proposed Guideline for Reporting Evidence-based practice Educational intervention and Teaching (GREET) items. This thorough description will facilitate the interpretation of future research and implementation of the intervention. Our approach can also serve as a model for others considering online EBP intervention development.背景：使用网络教育干预措施教 导询证实践 (EBP) 是一种潜力巨 大的机制，用于克服某些障碍， 将研究融入实践。但是必须注意 使用成人学习理论调整策略，达 到最佳效果。方法：本文描述了一系列短期自学 模块的开发过程，每个模块涵盖一 小部分学习目标。我们的方法依据 设计型研究 (DBR) 形成，涉及 6 个阶段：分析、设计、设计评价、 再设计、开发/实施和评价。参加 者是在补充和综合教育机构参加 3 个健康项目的机构和学生。结果：我们选择了一种可重复使用 的学习对象法，这种方法允许我们 使用 4 种主要学习理论：教学事 件、认知负荷、双重处理和 ARCS（注意、相关性、自信和满 意）。形成性设计评价表明，鉴别 理论和教学方法很有可能方便学习 和提供动机。根据一项关注这些理 论如何支持学习的学生调查 (n=116) ，我们进行了总结性评 价。结果表明，选择的理论整体上 有助于学生学习。结论：DBR 方法允许我们评价特 定的干预和理论的普适性。本方 法还有助于我们详细定义和记录 干预措施，涵盖几乎所有预期的 报告询证实践教育干预和教学指 南 (GREET) 项目。此项全面描述 将促进未来研究的解释和干预实 施。我们的方法还能作为一个模 型，供其他人开发在线 EBP 干预 措施时使用。.las intervenciones educativas en línea para la enseñanza de la práctica empírica (Evidence-based Practice, EBP) son un mecanismo prometedor para superar algunos de los obstáculos para la incorporación de la investigación en la práctica. Sin embargo, se debe prestar atención a las estrategias de armonización con las teorías de aprendizaje de adultos para conseguir resultados óptimos.describimos el desarrollo de una serie de módulos de autoaprendizaje de corta duración, cada uno de los cuales cubre un conjunto reducido de objetivos. Nuestro enfoque, fundamentado en la investigación basada en el diseño (Design-based research, DBR), abarcó 6 fases: análisis, diseño, evaluación del diseño, rediseño, desarrollo/implantación y evaluación. Los participantes eran profesores y estudiantes de 3 programas de salud de una institución educativa complementaria e integral.optamos por un enfoque orientado a objetos de aprendizaje reutilizables que nos permitieron aplicar 4 teorías principales de aprendizaje: pasos de instrucción, carga cognitiva, procesos paralelos y ARCS (atención, relevancia, confianza, satisfacción). Una evaluación formativa de diseño sugirió que las teorías y métodos de instrucción identificados podían facilitar el aprendizaje y la motivación. La evaluación sumativa se basó en una encuesta estudiantil (n=116) que versó sobre cómo estas teorías apoyaban el aprendizaje. Los resultados apuntaron a que, en general, las teorías seleccionadas ayudaron a los estudiantes a aprender.el enfoque DBR nos permitió evaluar la intervención y las teorías específicas de aplicación general. Además, este proceso nos ayudó a definir y documentar la intervención a un nivel de detalle que cubre casi la totalidad de la Directriz propuesta para el informe de intervenciones educativas y enseñanzas de la práctica empírica (Guideline for Reporting Evidence-based practice Educational intervention and Teaching, GREET). Esta descripción detallada facilitará la interpretación de la investigación y aplicación futuras de la intervención. Nuestro enfoque también puede servir como modelo para aquellos que consideren el desarrollo de la intervención EBP en línea.

The world's population is aging quickly, leading to increased challenges of how to care for individuals who can no longer independently care for themselves. With global social and economic pressures leading to declines in family support, increased reliance is being placed on community- and government-based facilities to provide long-term care (LTC) for many of society's older citizens. Complementary and integrative healthcare (CIH) is commonly used by older adults and may offer an opportunity to enhance LTC residents' wellbeing. Little work has been done, however, rigorously examining the safety and effectiveness of CIH for LTC residents.The goal of this work is to describe a pilot project to develop and evaluate one model of CIH in an LTC facility in the Midwestern United States.A prospective, mixed-methods pilot project was conducted in two main phases: (1) preparation and (2) implementation and evaluation. The preparation phase entailed assessment, CIH model design and development, and training. A CIH model including acupuncture, chiropractic, and massage therapy, guided by principles of collaborative integration, evidence informed practice, and sustainability, was applied in the implementation and evaluation phase. CIH services were provided for 16 months in the LTC facility. Quantitative data collection included pain, quality of life, and adverse events. Qualitative interviews of LTC residents, their family members, and LTC staff members queried perceptions of CIH services.A total of 46 LTC residents received CIH care, most commonly for musculoskeletal pain (61%). Participants were predominantly female (85%) and over the age of 80 years (67%). The median number of CIH treatments was 13, with a range of 1 to 92. Residents who were able to provide self-report data demonstrated, on average, a 15% decline in pain and a 4% improvement in quality of life. No serious adverse events related to treatment were documented; the most common mild and expected side effect was increased pain (63 reports over 859 treatments). Qualitative interviews revealed most residents, family members and LTC staff members felt CIH services were worthwhile due to perceived benefits including pain relief and enhanced psychological and social wellbeing.This project demonstrated that with extensive attention to preparation, one patient-centered model of CIH in LTC was feasible on several levels. Quantitative and qualitative data suggest that CIH can be safely implemented and might provide relief and enhanced wellbeing for residents. However, some aspects of model delivery and data collection were challenging, resulting in limitations, and should be addressed in future efforts.简介：世界人口迅速老龄化，导 致如何照顾那些不能再独立照顾 自己的老人的挑战日益严峻。随 着全球社会和经济压力，导致家 庭赡养能力下降，更多依赖以社 区和政府为基础的设施，为许多 社会的老年公民提供长期护理 （LTC）。老年人经常使用补充和 综合医疗保健（CIH），CIH 并可 能提供一个机会以改善 LTC 居民 的福祉。然而，针对 LTC 居民的 CIH 安全性和有效性而进行的严格 检验不多。目的：这项工作的目标是描述一 个试点项目，以开发和评估一个 在美国中西部的 LTC 设施的 CIH 模型。方法：前瞻性、混合方法试点项 目主要分两个阶段进行：（1）准 备和（2）实施和评估。准备阶段 牵涉到评估、CIH 模型设计和开发 以及培训。一个 CIH 模型包括针 灸、整脊、按摩疗法，通过协同 整合、证据告知做法和可持续发 展的原则为指导，在实施和评估 阶段进行应用。该 LTC 设施提供 了 CIH 服务 16 个月。定量数据 收集包括疼痛、生活质量和不良 反事件。与 LTC 居民、其家庭成 员和 CIH 服务看法查询的 LTC 工 作人员进行定性访谈。结果：一共有 46 位 LTC 居民进 行了 CIH 护理，肌肉骨骼疼痛护 理（61%）最为普遍。参与者以女 性（85%）和 80 岁以上 （67%） 为主。CIH 治疗的中位数是 13， 范围是 1 到 92。居民们能够提供 自我报告的数据表明 ， 平均来 看，15% 减轻了疼痛且 4% 改善了 生活质量。没有与治疗相关的严 重不良事件记录在案；最常见的 轻度和预期副作用是疼痛增加 （859 例治疗中有 63 份报告）。 定性访谈显示，大多数居民、家 庭成员和 LTC 工作人员认为：由 于感知的益处（包括缓解疼痛、 增强心理和社会福祉），因此 CIH 服务是值得的。结论：这一项目表明，广泛关注 准备工作，一个以患者为中心的 CIH 模型在 LTC 在几个层面上是 可行的。 定量和定性数据表 明，CIH 可以安全地实施并且可为 居民减轻疼痛和增加福祉。 然而，模型传递和数据收集的某些 方 面 都具有挑战性，造成局限性，应在今后的工作中解决。

Study Design Cross-sectional. Background Although low back pain (LBP) occurs commonly in adolescence, little is known about the relationship between objectively measured physical activity and chronic LBP. Objectives To assess the relationship between an objective physical activity measure (accelerometer) and standard clinical measures (pain intensity, disability, and quality of life) in a sample of adolescents with recurrent or chronic LBP. Methods The study included a subsample of 143 adolescents, 12 to 18 years of age, from a randomized clinical trial. Pearson correlations (r) and bivariate linear regression were used to assess the relationship between baseline measures of sedentary, light, and moderate-to-vigorous physical activity using accelerometers and clinical measures of LBP (pain intensity, disability, and quality of life). Results Participants spent an average of 610.5 minutes in sedentary activity, 97.6 minutes in light physical activity, and 35.6 minutes in moderate-to-vigorous physical activity per day. Physical activity was very weakly associated with clinical measures of LBP (r

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objectives of the review are to quantify and compare the short‐ and long‐term effects of manual treatment and spinal rehabilitative exercise for episodic and chronic migraine classified according to the International Headache Societies (IHS) diagnostic criteria.

This is the protocol for a review and there is no abstract. The objectives are as follows: To quantify and compare the short- and long-term effects of manual treatment and spinal rehabilitative exercise for cervicogenic headache, classified according to the International Headache Society's (IHS) diagnostic criteria, with an active or placebo/sham comparison or wait-list control.

Objectives: To present the varied approaches of 9 complementary and alternative medicine (CAM) institutions (all grantees of the National Center for Complementary and Alternative Medicine) used to develop faculty expertise in research literacy and evidence-based practice (EBP) in order to integrate these concepts into CAM curricula. Design: A survey to elicit information on the faculty development initiatives was administered via e-mail to the 9 program directors. All 9 completed the survey, and 8 grantees provided narrative summaries of faculty training outcomes. Results: The grantees found the following strategies for implementing their programs most useful: assess needs, develop and adopt research literacy and EBP competencies, target early adopters and change leaders, employ best practices in teaching and education, provide meaningful incentives, capitalize on resources provided by grant partners, provide external training opportunities, and garner support from institutional leadership. Instructional approaches varied considerably across grantees. The most common were workshops, online resources, in-person short courses, and in-depth seminar series developed by the grantees. Many also sent faculty to intensive multiday extramural training programs. Program evaluation included measuring participation rates and satisfaction and the integration of research literacy and EBP learning objectives throughout the academic curricula. Most grantees measured longitudinal changes in beliefs, attitudes, opinions, and competencies with repeated faculty surveys. Conclusions: A common need across all 9 CAM grantee institutions was foundational training for faculty in research literacy and EBP. Therefore, each grantee institution developed and implemented a faculty development program. In developing the framework for their programs, grantees used strategies that were viewed critical for success, including making them multifaceted and unique to their specific institutional needs. These strategies, in conjunction with the grantees' instructional approaches, can be of practical use in other CAM and non-CAM academic environments considering the introduction of research literacy and EBP competencies into their curricula.

PURPOSE: Global Perceived Effect (GPE) is a commonly used outcome measure for musculoskeletal conditions like neck pain; however, little is known regarding the factors patients take into account when determining their GPE. The overall objective of this work was to describe the thematic variables, which comprise the GPE from the patient's perspective.METHODS: This was a mixed-methods study in which qualitative data were collected within a randomized clinical trial assessing exercise and manual therapy for chronic neck pain. A consecutive sample of 106 patients who completed the trial intervention took part in semi-structured interviews querying the meaning of GPE. Quantitative measures were collected through self-report questionnaires. Interview transcripts were analyzed using content analysis to identify themes, which were then quantified to assess potential relationships.RESULTS: A model of GPE for chronic neck pain emerged comprised of five main themes: neck symptoms (cited by 85 %), biomechanical performance (38 %), activities of daily living (31 %), self-efficacy (10 %), and need for other treatment (6 %). Influencing factors included those contributing to GPE: treatment process (64 %), biomechanical performance (51 %), self-efficacy (16 %), and the nature of the condition (8 %). Factors, which detracted from GPE or prevented recovery included perceived nature of condition (58 %), required daily activities (10 %), lack of diagnosis (5 %), and history of failed treatment (5 %).CONCLUSIONS: GPE appears to capture chronic neck pain patient perceptions of change in different domains important to their individual pain experiences that may not be captured by other outcome instruments. Thus, GPE is a suitable patient-oriented outcome that can complement other measures in research and clinical practice. Importantly, many chronic neck pain patients believe it impossible to reach complete recovery because of a perceived intractable aspect of their neck condition; this has important implications regarding long-term disability and health-seeking behaviors.

Purpose: The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment. Methods: This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software. Results: LBP patients' expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations. Conclusion and recommendations: This study showed that LBP patients' expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients' treatment expectations and improving health outcomes. © 2013 Springer-Verlag Berlin Heidelberg.

Background Patient perceptions may influence the effectiveness and utilization of healthcare interventions, particularly for complex health conditions such as sciatica or back-related leg pain (BRLP). Objectives To explore BRLP patients' perceptions of spinal manipulative therapy (SMT) and home exercise with advice (HEA). Design Qualitative study in a controlled clinical trial. Method Semi-structured interviews conducted after 12 weeks of treatment asked participants about satisfaction with care and whether treatment was worthwhile. An interdisciplinary research team conducted content analysis using qualitative data analysis software to identify and summarize themes. Results Of 192 trial participants, 174 (91%) completed interviews (66% female, age 57.0 ± 11.5 years). Participants identified interactions with providers and staff, perceived treatment effects, and information as key contributors to both their satisfaction and the worthwhile nature of treatment. HEA was liked for its convenience and ability to foster an exercise habit. SMT was liked for specific aspects of the modality (e.g. manipulation, stretching) and provider competency. Most participants reported no dislikes for SMT or HEA, but some noted the dose/time commitment for SMT and discipline of HEA as least liked aspects of the interventions. Conclusions The quality of patient–provider interactions, perceived treatment effects, and information sharing influenced BRLP patients' satisfaction with care. Qualitative research describing patients' preferences can facilitate translation of study findings into practice and allow clinicians to tailor treatments to facilitate compliance and satisfaction with care.

Background Context Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments. Purpose This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA. Study Design/Setting Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed. Patient Sample A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample. Outcome Measures The outcome measures were direct and indirect costs, neck pain, neck disability, SF-6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1-year time horizon. Methods This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308). A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectivenesswas a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates. Results Total costs for SMT+HEA were 5% lower than HEA (mean difference: −$111; 95% confidence interval [CI] −$1,354 to $899) and 47% lower than SRE+HEA (mean difference: −$1,932; 95% CI −$2,796 to −$1,097). SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and QALYs favored SMT+HEA. The probability that adding SMT to HEA is cost-effective at willingness to pay thresholds of $50,000 to $200,000 per QALY gained ranges from 0.75 to 0.81. If adopting a health-care perspective, costs for SMT+HEA were 66% higher than HEA (mean difference: $515; 95% CI $225 to $1,094), resulting in an ICER of $55,975 per QALY gained. Conclusion On average, SMT+HEA resulted in better clinical outcomes and lower total societal costs relative to SRE+HEA and HEA alone, with a 0.75 to 0.81 probability of cost-effectiveness for willingness to pay thresholds of $50,000 to $200,000 per QALY.

Cervicogenic headache is a prevalent and costly pain condition commonly treated by chiropractors. There is evidence to support the effectiveness for spinal manipulation, but the dose of treatment required to achieve maximal relief remains unknown. The purpose of this paper is to describe the methodology for a randomized controlled trial evaluating the dose–response of spinal manipulation for chronic cervicogenic headache in an adult population. This is a mixed-methods, two-site, prospective, parallel groups, observer-blind, randomized controlled trial conducted at university-affiliated research clinics in the Portland, OR and Minneapolis, MN areas. The primary outcome is patient reported headache frequency. Other outcomes include self-reported headache intensity, disability, quality of life, improvement, neck pain intensity and frequency, satisfaction, medication use, outside care, cervical motion, pain pressure thresholds, health care utilization, health care costs, and lost productivity. Qualitative interviews are also conducted to evaluate patients’ expectations of treatment. With growing concerns regarding the costs and side effects of commonly used conventional treatments, greater numbers of headache sufferers are seeking other approaches to care. This is the first full-scale randomized controlled trial assessing the dose–response of spinal manipulation therapy on outcomes for cervicogenic headache. The results of this study will provide important evidence for the management of cervicogenic headache in adults. ClinicalTrials.gov (Identifier: NCT01530321 )

Objective: Most health professions recognize the value of evidence-based practice (EBP), yet the uptake of EBP across most health disciplines has been suboptimal. To improve EBP uptake, it is important to first understand the many dimensions that affect EBP use. The Evidence-Based practice Attitude and utilization SurvEy (EBASE) was designed to measure the attitudes, skills, and use of EBP among practitioners of complementary and alternative medicine (CAM); however, the dimensionality of the instrument is not well understood. The aim of the current research was to examine the psychometric properties of the attitudes, skills, and use subscales of EBASE. Design: This was a secondary analysis of data obtained from the administration of EBASE. Data were examined using principal components analyses and confirmatory methods. Internal consistency reliabilities of resultant subscales were also computed. Participants: 1314 U.S. chiropractors and 554 Canadian chiropractors. Results: A unidimensional structure best fit the attitudes and use subscales. Skills subscale items were best represented by subscales with a multidimensional structure. Specifically, the skills construct was best modeled with three dimensions (identification of the research question, locating research, and application of EBP). All subscales had acceptable internal consistency reliability estimates. Conclusions: The findings support the modification of the scoring guidelines for the original EBASE. These changes are likely to result in a more accurate measure of EBP attitudes, skills, and use among chiropractors, and possibly CAM providers more generally. Refereed/Peer-reviewed

Many people suffering from low back pain (LBP) have found conventional medical treatments to be ineffective for managing their LBP and are increasingly turning to complementary and alternative medicine (CAM) to find pain relief. A comprehensive picture of CAM use in the LBP population, including all of the most commonly used modalities, is needed.To examine prevalence and perceived benefit of CAM use within the US LBP population by limiting vs nonlimiting LBP and to evaluate the odds of past year CAM use within the LBP population.Data are from the 2012 National Health Interview Survey, Alternative Health Supplement. We examined a nationally representative sample of US adults with LBP (N=9665 unweighted). Multiple logistic regression was used to estimate the odds of past year CAM use.In all, 41.2% of the LBP population used CAM in the past year, with higher use reported among those with limiting LBP. The most popular therapies used in the LBP population included herbal supplements, chiropractic manipulation, and massage. The majority of the LBP population used CAM specifically to treat back pain, and 58.1% of those who used CAM for their back pain perceived a great deal of benefit.The results are indicative of CAM becoming an increasingly important component of care for people with LBP. Additional understanding of patterns of CAM use among the LBP population will help health professionals make more informed care decisions and guide investigators in development of future back pain-related CAM research.背景：许多有腰背痛 (Low Back Pain, LBP) 的人都发现常规药物治疗不足以管理其腰背痛，并越来越多地转向补充和替代医学 (Complementary and Alternative Medicine, CAM) 来疼痛缓解。需要全面描绘 CAM 在 LBP 人群中的使用情况，包括所有最常用的方式。研究目标：通过限制性与非限制性 LBP 考察在美国 LBP 人群中使用 CAM 的普遍性和感知利益，同时评估去年在 LBP 人群中使用 CAM 的几率。方法：数据来自于 2012 年国家健康访谈调查，替代健康补充。我们考察了美国成人 LBP 患者的全国代表性样本（N=9665，未加权）。使用多次逻辑回归估计去年使用 CAM的几率。结果：总体而言，41.2% 的 LBP 人群去年使用了 CAM，其中在限制性 LBP 患者中报告的使用率较高。LBP人群中使用最多的疗法包括草药补充剂、整脊疗法和按摩。多数 LBP人群使用了专用于治疗背痛的 CAM，在使用 CAM 治疗背痛者中，58.1% 感觉受益匪浅。结论：结果表明，CAM 正成为 LBP病患护理越来越重要的组成部分。进一步了解 CAM 在 LBP 人群中的使用方式将帮助卫生保健专业人员作出更加知情的护理决定，并指导研究者发展未来的背痛相关 CAM 研究。.Muchas personas que sufren lumbalgia han descubierto que los tratamientos médicos convencionales no son eficaces para tratarla y están cambiando a la medicina complementaria y alternativa para encontrar el alivio a su dolor. Es necesario tener una imagen completa del uso de la medicina complementaria y alternativa en la población con lumbalgia, incluidas todas las modalidades usadas de forma más frecuente.Investigar la prevalencia y el beneficio percibido a partir del uso de la medicina complementaria y alternativa en la población estadounidense con lumbalgia y evaluar las posibilidades del uso de la medicina complementaria y alternativa del año pasado dentro de la población con lumbalgia.Los datos provienen de la Encuesta nacional de entrevistas sobre salud de 2012, complemento de la salud alternativa. Examinamos una muestra representativa a nivel nacional de los adultos estadounidenses con lumbalgia (N=9665 sin ponderar). Se usó el modelo de regresión logístico múltiple para calcular las posibilidades del uso de la medicina complementaria y alternativa en el año pasado.En general, el 41,2 % de la población con lumbalgia usó la medicina complementaria y alternativa durante el último año, con un uso mayor comunicado entre aquellas personas con lumbalgia limitante. Los tratamientos más populares usados en la población con lumbalgia incluían los complementos a base de hierbas, la manipulación quiropráctica y el masaje. La mayor parte de la población con lumbalgia utilizó la medicina complementaria y alternativa específicamente para tratar la lumbalgia y 58,1 % de los que utilizaron la medicina complementaria y alternativa para la lumbalgia notaron un beneficio muy grande.Los resultados son indicativos de que la medicina complementaria y alternativa se está convirtiendo en un componente de tratamiento cada vez más importante para las personas con lumbalgia. El conocimiento complementario de pautas de uso de medicina complementaria y alternativa entre la población con lumbalgia ayudará a los profesionales sanitarios a tomar decisiones de tratamiento más informadas y a guiar a los investigadores en el desarrollo de la investigación futura en materia de medicina complementaria y alternativa relacionada con la lumbalgia.