Multidisciplinary integrative care versus chiropractic care for low back pain: a randomized clinical trial

doi:10.1186/s12998-022-00419-3

Table 1

Description of interventions using the Template for Intervention Description and Replication (TIDieR) [27]

1. Brief name Monodisciplinary Chiropractic Care (CC) [24] Multidisciplinary Integrative Care (IC) [24]
2.Why Rationale: Chiropractors commonly treat LBP patients with evidence-based modalities found to be effective for LBP Rationale: Given the biopsychosocial nature of LBP, integrating multiple types of evidence-based modalities may exceed the therapeutic effect of any one modality alone; one approach is multidisciplinary integrative care
3. What Materials
Patients: handouts with pictures and descriptions of exercises and self-care postures
Providers: manuals of operations, standardized treatment notes
4. What Procedures
Manual spinal manipulation (i.e., high velocity, low amplitude thrust techniques, with or without the assistance of a drop table)
Manual mobilization (i.e., low velocity, low amplitude thrust techniques, with or without the assistance of a flexion-distraction table)
Spinal mobility, strength/endurance, and stabilization exercises
Adjunct therapies common to clinical practice (i.e. hot and cold packs, soft tissue massage)
Traditional Chinese Medicine (i.e. acupuncture, liquid moxa with a heat lamp, Tui Na, and cupping)
Chiropractic care (including spinal manipulation, manual mobilization, adjunct therapies as described in CC group)
Cognitive behavioral therapy (i.e. operant and respondent cognitive approaches including environmental restructuring)
Rehabilitative exercise (i.e. spinal mobility, strength/endurance and stabilization exercises)
Therapeutic massage (i.e. neuromuscular therapy, myofascial techniques, trigger point therapy, and classic western style Swedish massage)
Medication (i.e. non-steroidal anti-inflammatory drugs (NSAIDS), analgesics, and/or muscle relaxants)
Self-care education (i.e. spine posture awareness for activities of daily living specific to their abilities, such as lifting, pushing and pulling, sitting and getting out of bed)
5. Who
3 licensed chiropractors; met weekly as a team
Training included review of evidence for specific modalities; collaborative evidence-based decision making
13 licensed or certified practitioners (3 Traditional Chinese Medicine, 2 chiropractors, 3 massage therapists, 2 psychologists, 1 allopathic physician, and 2 exercise therapists); met weekly as team
Study related training included orientation to different treatments and practices (theoretical mechanisms, modalities); review of evidence for specific modalities; collaborative evidence-based decision making
6. How 1:1 visits; in person
7. Where Research clinic
8. When, how much 12 weeks intervention period; number of visits based on individual patient needs; typical visit duration 15–30 min 12 weeks intervention period; number of visits based on individual patient needs; typical visit duration varied by treatment type: Cognitive Behavioral Therapy, Massage Therapy (60 min); Traditional Chinese Medicine, Exercise and Self-Care Education (40–60 min); Chiropractic Care (15–30 min); Medication- 15–30 min
9. Tailoring
Treatment plan options based on care team’s evaluation of the patient profile generated from baseline health history, physical examination findings, and patient rated outcomes measures
Treatment plans presented by case manager, and selected by study participant
Decision regarding number and frequency of treatment visits based on patient response to treatment (i.e. self-selected symptom and activity ratings) using a Patient Self-Assessment Form
10. Modifications None
11. Planned Fidelity Assessment
Routine monitoring of standardized treatment notes by research staff
Patient self-report of out-of-scope care during intervention phase
12. Actual Fidelity Assessment 3 patients sought additional care during intervention phase 1 patient sought additional care during intervention phase

1. Brief name	Monodisciplinary Chiropractic Care (CC) [24]	Multidisciplinary Integrative Care (IC) [24]
2.Why	Rationale: Chiropractors commonly treat LBP patients with evidence-based modalities found to be effective for LBP	Rationale: Given the biopsychosocial nature of LBP, integrating multiple types of evidence-based modalities may exceed the therapeutic effect of any one modality alone; one approach is multidisciplinary integrative care
3. What Materials	Patients: handouts with pictures and descriptions of exercises and self-care postures Providers: manuals of operations, standardized treatment notes
4. What Procedures	Manual spinal manipulation (i.e., high velocity, low amplitude thrust techniques, with or without the assistance of a drop table) Manual mobilization (i.e., low velocity, low amplitude thrust techniques, with or without the assistance of a flexion-distraction table) Spinal mobility, strength/endurance, and stabilization exercises Adjunct therapies common to clinical practice (i.e. hot and cold packs, soft tissue massage)	Traditional Chinese Medicine (i.e. acupuncture, liquid moxa with a heat lamp, Tui Na, and cupping) Chiropractic care (including spinal manipulation, manual mobilization, adjunct therapies as described in CC group) Cognitive behavioral therapy (i.e. operant and respondent cognitive approaches including environmental restructuring) Rehabilitative exercise (i.e. spinal mobility, strength/endurance and stabilization exercises) Therapeutic massage (i.e. neuromuscular therapy, myofascial techniques, trigger point therapy, and classic western style Swedish massage) Medication (i.e. non-steroidal anti-inflammatory drugs (NSAIDS), analgesics, and/or muscle relaxants) Self-care education (i.e. spine posture awareness for activities of daily living specific to their abilities, such as lifting, pushing and pulling, sitting and getting out of bed)
5. Who	3 licensed chiropractors; met weekly as a team Training included review of evidence for specific modalities; collaborative evidence-based decision making	13 licensed or certified practitioners (3 Traditional Chinese Medicine, 2 chiropractors, 3 massage therapists, 2 psychologists, 1 allopathic physician, and 2 exercise therapists); met weekly as team Study related training included orientation to different treatments and practices (theoretical mechanisms, modalities); review of evidence for specific modalities; collaborative evidence-based decision making
6. How	1:1 visits; in person
7. Where	Research clinic
8. When, how much	12 weeks intervention period; number of visits based on individual patient needs; typical visit duration 15–30 min	12 weeks intervention period; number of visits based on individual patient needs; typical visit duration varied by treatment type: Cognitive Behavioral Therapy, Massage Therapy (60 min); Traditional Chinese Medicine, Exercise and Self-Care Education (40–60 min); Chiropractic Care (15–30 min); Medication- 15–30 min
9. Tailoring	Treatment plan options based on care team’s evaluation of the patient profile generated from baseline health history, physical examination findings, and patient rated outcomes measures Treatment plans presented by case manager, and selected by study participant Decision regarding number and frequency of treatment visits based on patient response to treatment (i.e. self-selected symptom and activity ratings) using a Patient Self-Assessment Form
10. Modifications	None
11. Planned Fidelity Assessment	Routine monitoring of standardized treatment notes by research staff Patient self-report of out-of-scope care during intervention phase
12. Actual Fidelity Assessment	3 patients sought additional care during intervention phase	1 patient sought additional care during intervention phase