Research Brief
Chiropractors in the United States Rarely Perform Spinal Manipulation for Chronic Lower Back or Neck Pain When It Is Inappropriate
Across a sample of patients seen by chiropractors, spinal manipulation was rated by experts as appropriate for most patients with chronic lower back pain and as equivocal (uncertain) for most patients with chronic neck pain.
Mar 12, 2021
Journal Article
Update of Markov Model on the Cost-effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care
Markov modeling facilitates comparisons across interventions for lower back pain not directly compared in trials.
Dec 16, 2020
Tool
How Would a Better Diet Affect Health and Economic Outcomes in the United States?
An online tool shows the effect that improving diet quality in the United States could have on health and economic outcomes, such as the prevalence of diet-related illness, health care spending, and labor force participation, over a 30-year period.
Sep 21, 2020
Journal Article
Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part 5: Selection, Protection, and Abstraction
Of the records abstracted, many revealed incomplete provider documentation regarding the details of and rationale for care. Better documentation and more standardized record keeping would facilitate future research using patient records.
2019
Journal Article
Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part 4: Putting Practice Back Into Evidence-based Practice by Recruiting Clinics and Patients
This study found that clinics can be successfully recruited for practice-based studies, and patients can be recruited using iPads. Obtaining patient records presents considerable challenges, and clinics varied in whether they had electronic files, nonelectronic records, or a mixture.
2019
Journal Article
Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part 3: Designing Instruments With Patient Input
This article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.
2019
Journal Article
Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors
Persons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients' beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain.
2019
Journal Article
The Research Crisis in American Institutions of Complementary and Integrative Health: One Proposed Solution for Chiropractic Profession
The future success of CIH-directed research on CIH will require a pooling of talent and resources across institutions; something that the American chiropractic institutions have not yet been able to achieve. This article discusses one possible solution.
2019
Journal Article
Cost Analysis of a Randomized Trial of Getting to Outcomes Implementation Support of CHOICE in Boys and Girls Clubs in Southern California
This study estimates the societal costs of implementing CHOICE, a voluntary after-school alcohol and other drug prevention program for adolescents, in Boys and Girls Clubs across Southern California with and without an implementation support system called Getting To Outcomes.
Mar 11, 2020
Journal Article
The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs
The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.
2018
Journal Article
Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain
This study describes the characteristics of a large sample of chronic low back pain and chronic neck pain patients in the United States who use chiropractic care for their chronic low back pain and chronic neck pain.
2018
Journal Article
Community Health Workers as Focus Group Facilitators: A Participatory Action Research Method to Improve Behavioral Health Services for Farmworkers in a Primary Care Setting
Since 1965, Federally Qualified Health Centers have provided a safety net for the uninsured and major source of care to those enrolled in public health insurance programs. The distinguishing characteristic of the program is the concept of community governance in achieving the main objective to provide holistic, comprehensive, and culturally competent primary care to low-income and medically underserved areas.
2015
Journal Article
Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel
The purpose of this systematic review was to evaluate the randomized controlled trials published from January 2000 through September 2017 on chronic nonspecific neck pain, comparing the effects of manipulation and/or mobilization as therapies to those of other active therapies (such as acupuncture, massage therapy, exercise, etc.) to sham or no treatment, and when combined with other therapies such as exercise or advice commonly seen in practice.
Jun 11, 2019
Journal Article
Naturopathic Medicine for the Prevention of Cardiovascular Disease: A Randomized Clinical Trial
To evaluate the effectiveness of representative naturopathic approaches to reducing the risk of cardiovascular disease, we conducted a randomized clinical trial of a multimodality nutritional and physical activity intervention in a workplace setting.
2013
Journal Article
The Problematic Economics of Integrative Oncology
The economics of integrative oncology are problematic because of the lack of good studies, the lack of historic incentives for efficiency, and the high cost of cancer care and its financial toxicity on patients. However, these problems can be overcome, with help from one good economic evaluation at a time.
2018
Journal Article
Randomized Controlled Dissemination Study of Community-to-Clinic Navigation to Promote CRC Screening: Study Design and Implications
The purpose of this study is to extend the pilot study in a group-randomized controlled trial to test the effectiveness of tailored messaging delivered by Community Health Navigators to guide individuals from especially hard-to-reach, multicultural, and underinsured communities into primary care clinics for referral for CRC screening (Phase I) and to continue navigation after referral to track effects of the intervention on completion of CRC screening (Phase II).
2016
Journal Article
Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally
This article addresses the use of a variety of nonherbal CIH therapies among any large patient population having chronic pain by exploring the frequency and predictors of CIH therapy use among a national population of VHA users with chronic musculoskeletal pain.
Jun 11, 2019
Journal Article
The Use of Complementary and Integrative Health Approaches for Chronic Musculoskeletal Pain in Younger US Veterans: An Economic Evaluation
Chronic pain is prevalent among Veterans in general, but especially among younger Veterans, including participants in Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn. Musculoskeletal pain is the most common type of chronic pain. This pain also often co-occurs with conditions such as anxiety, depression, post-traumatic stress disorder, and substance abuse.
Jun 11, 2019
Journal Article
Yoga Versus Education for Veterans with Chronic Low Back Pain: Study Protocol For a Randomized Controlled Trial
This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities.
2016
Journal Article
Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results from a Markov Model
This study presents the results of a proof-of-concept modeling effort that utilized individual patient-level data from ten randomized studies and the categorization of these study's participants by chronic pain impact level to estimate the effectiveness and cost-effectiveness of adding recommended nonpharmacologic therapies for CLBP to usual care.
Jun 10, 2019
Journal Article
Clinical Scenarios for Which Spinal Mobilization and Manipulation Are Considered by an Expert Panel to Be Inappropriate (and Appropriate) for Patients With Chronic Low Back Pain
This study used the RUAM to determine the appropriateness of spinal mobilization and manipulation for different types of patients with CLBP, and the key patient characteristics associated with appropriateness.
Jun 10, 2019
Journal Article
Experiences With Chiropractic Care for Patients With Low Back or Neck Pain
This study provides information on the experiences of a national sample of chiropractic patients in the United States with chronic pain.
Jun 10, 2019
Journal Article
Patient Willingness to Pay for Reductions in Chronic Low Back Pain and Chronic Neck Pain
This study provides estimates of reported WTP for pain reduction from a large sample of patients using chiropractic care to manage their chronic spinal pain and compares these estimates to what these patients do for care over the next 3 months, to inform coverage policies for ongoing care.
Jun 10, 2019
Journal Article
Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part I
In this series of articles, we describe how we gathered the varied and detailed data required to achieve the following study objectives: (1) to measure the appropriateness of M/M for CLBP and CCP and (2) to determine whether patient preferences and costs affect appropriateness, and further, whether appropriateness affects outcomes.
Jun 10, 2019
Journal Article
Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part 2: What Every Researcher and Practitioner Should Know About the Health Insurance Portability and Accountability Act and Practice-based Research in the United States
In this series of articles, we describe how we gathered the varied and detailed data required to achieve the following study objectives: (1) to measure the appropriateness of M/M for CLBP and CCP and (2) to determine whether patient preferences and costs affect appropriateness, and further, whether appropriateness affects outcomes.
Jun 10, 2019
Journal Article
Exploring the Prevalence and Construct Validity of High-Impact Chronic Pain Across Chronic Low-Back Pain Study Samples
Identifying high-impact chronic pain and reporting outcomes of trials by chronic pain impact level could help ensure that adequate resources are directed toward improving outcomes of the chronic pain patients in greatest need.
Apr 11, 2019
Journal Article
Healthcare Costs and Opioid Use Associated with High-Impact Chronic Spinal Pain in the United States
Opioid dosage and use increased annually for individuals with all levels of chronic pain; those with high-impact pain had average dosing 5.5 times higher than those with low-impact pain.
Apr 11, 2019
Report
Determining the Appropriateness of Spinal Manipulation and Mobilization for Chronic Low Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel
This report describes the results and methodology of convened panels of back pain experts who met to discuss and rate appropriateness of 450 indications for spinal manipulation and mobilization for chronic low back pain.
Jul 24, 2018
Report
Determining the Appropriateness of Spinal Manipulation and Mobilization for Chronic Neck Pain: Indications and Ratings by a Multidisciplinary Expert Panel
This report describes the results and methodology of convened panels of neck pain experts who met to discuss and rate appropriateness of 186 indications for spinal manipulation and mobilization for chronic neck pain.
Jul 24, 2018
Journal Article
Cognitive and Mind-Body Therapies for Chronic Low Back Pain and Neck Pain: Effectiveness and Value
A recent Institute for Clinical and Economic Review provides evidence that some cognitive and mind-body therapies are effective for chronic low back pain and also cost-effective.
Apr 18, 2018
Journal Article
Manipulation and Mobilization for Treating Chronic Low Back Pain: A Systematic Review and Meta-Analysis
Moderate-quality evidence suggests that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to have the larger effect.
Mar 2, 2018
Journal Article
Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain
CLBP is expensive in terms of healthcare costs and lost productivity. Mind-body interventions have been found effective for back pain, but their cost-effectiveness is unexplored.
2017
Journal Article
The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps
The National Cancer Institute's "Acupuncture for Cancer Symptom Management" symposium reviewed the evidence on acupuncture use for clinical oncology treatment; this paper provides a summary and recommendations for future research.
Dec 15, 2017
Journal Article
Comparative Effectiveness Research in Integrative Oncology
Future research in the field of integrative oncology should incorporate comparative effectiveness research stakeholders, patient-reported outcomes, and economic evaluations.
Dec 15, 2017
Journal Article
A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic
An interdisciplinary approach to management of chronic pediatric pain can reduce costs for hospitals and insurers.
Dec 14, 2017
Journal Article
Complementary and Alternative Medicine Services in the Military Health System
Complementary and alternative medicine services are offered in the majority of military treatment facilities to address service members' pain and mental health needs.
Oct 31, 2017
Report
Complementary and Alternative Medicine in the Military Health System
This report presents the results of a survey on complementary and alternative medicine (CAM) services fielded in 142 military treatment facilities across three branches of military service and the National Capital Region Medical Directorate.
Aug 9, 2017
Journal Article
Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial
A structured yoga program for patients with chronic lower back pain may be a reasonable alternative to physical therapy, depending on patient preferences, availability, and cost.
Aug 2, 2017
Journal Article
Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis
The policy environment related to complementary and alternative medicine (CAM) would benefit from a discussion involving a wide range of stakeholders about how to unify definitions of CAM as a collection of treatments vs. CAM as a professional field.
Sep 12, 2016
Journal Article
A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care
Conjoint analysis, used to capture consumer preferences for designing products, can be used to package more effective mental health services for low-income Hispanics within a community-based participatory research framework.
Jul 14, 2016
Journal Article
Using Participatory Methods to Enhance Patient-Centred Mental Health Care in a Federally Qualified Community Health Center Serving a Mexican American Farmworker Community
Using a community-based participatory approach, this study provided rich data regarding patient preferences for mental health care in a Mexican farmworker community, enabling a federally qualified health centre serving the community to provide patient-centered mental health care.
2015
Research Brief
Advancing Complementary and Alternative Medicine Professions: Practitioners Face Many Policy Hurdles to Finding Their Place in Mainstream Medicine
The policy challenges associated with coverage, licensure, scope of practice, institutional privileges, and research may prevent complementary and alternative medicine professionals from practicing to the full extent of their capabilities.
Feb 8, 2016
Journal Article
Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care
This study examines mental health services preferences of a low-income Hispanic farmworker population in southwestern Arizona.
Nov 18, 2015
Report
Acupuncture for Major Depressive Disorder: A Systematic Review
RAND researchers conducted a systematic review that synthesized evidence from trials of acupuncture to assess its efficacy and safety in treating major depressive disorder.
Oct 7, 2015
Report
Meditation for Major Depressive Disorder: A Systematic Review
RAND researchers conducted a systematic review that synthesized evidence from trials of mindfulness-based cognitive therapy to assess its efficacy and safety in treating major depressive disorder.
Oct 7, 2015
Report
Complementary and Alternative Medicine: Professions or Modalities? Policy Implications for Coverage, Licensure, Scope of Practice, Institutional Privileges, and Research
This report explores the policy challenges associated with coverage, licensure, scope of practice, institutional privileges, and research among the complementary and alternative medicine professions.
Oct 2, 2015
Journal Article
Out-of-pocket Expenditures on Complementary Health Approaches Associated with Painful Health Conditions in a Nationally Representative Adult Sample
National surveys suggest that millions of adults in the United States use complementary health approaches such as acupuncture, chiropractic manipulation, and herbal medicines to manage painful conditions such as arthritis, back pain and fibromyalgia.
Sep 14, 2015
Journal Article
Cost-benefit Analysis of a Preventive Intervention for Divorced Families: Reduction in Mental Health and Justice System Service Use Costs 15 Years Later
This cost-benefit analysis compared the costs of implementing the New Beginnings Program (NBP), a preventive intervention for divorced families to monetary benefits saved in mental healthcare service use and criminal justice system costs.
2015
Journal Article
Comparison of Complementary and Alternative Medicine with Conventional Mind–body Therapies for Chronic Back Pain: Protocol for the Mind–body Approaches to Pain (MAP) Randomized Controlled Trial
Cognitive-behavioral therapy (CBT), which addresses psychosocial factors, has been found to be effective for back pain, but access to qualified therapists is limited. Another treatment option with potential for addressing psychosocial issues, mindfulness-based stress reduction (MBSR), is increasingly available.
Jun 1, 2014
Journal Article
A Naturopathic Approach to the Prevention of Cardiovascular Disease: Cost-Effectiveness Analysis of a Pragmatic Multi-Worksite Randomized Clinical Trail
A naturopathic approach to CVD primary prevention significantly reduced CVD risk over usual care plus biometric screening and reduced costs to society and employers in this multi-worksite—based study.
Feb 1, 2014
Journal Article
Yoga Vs. Physical Therapy Vs. Education for Chronic Low Back Pain in Predominantly Minority Populations: Study Protocol for a Randomized Controlled Trial
Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown.
Feb 1, 2014
Journal Article
IMPACT - Integrative Medicine Primary Care Trial: Protocol for a Comparative Effectiveness Study of the Clinical and Cost Outcomes of an Integrative Primary Care Clinic Model
This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona.
2014
Journal Article
Evaluating the Economics of Complementary and Integrative Medicine
If CIM is to be considered in broader healthcare strategies, its economic impact must be determined.
Mar 1, 2013
Journal Article
Economic Analysis of Complementary, Alternative, and Integrative Medicine: Considerations Raised by an Expert Panel
An international panel of experts was convened to examine the challenges faced in conducting economic analyses of Complementary, Alternative and Integrative Medicine CAIM).
2013
Journal Article
When a Whole Practice Model Is the Intervention: Developing Fidelity Evaluation Components Using Program Theory-Driven Science for an Integrative Medicine Primary Care Clinic
This paper provides a rationale for the use of practice theory and fidelity evaluation in studies of integrative practices and describes the approach and protocol used in fidelity evaluation of the University of Arizona Integrative Health Center.
2013
Journal Article
Are Complementary Therapies and Integrative Care Cost-Effective? A Systematic Review of Economic Evaluations
A comprehensive systematic review of economic evaluations of complementary and integrative medicine (CIM) to establish the value of these therapies to health reform efforts.
2012
Journal Article
Hypothesized, Directly-Coded Curve Shapes in Growth Curve Analysis: An Example
This article presents a step-by-step example of the use and testing of hypothesized curve shapes in the estimation of growth curves using hierarchical linear modeling for a small intervention study.
2012
