Collaborative Care for Older Adults With Back Pain (COCOA)

As America ages, cost‐effective care for chronic diseases, such as low back pain, becomes
more important. Although estimates vary, 70‐85% of Americans will suffer from back pain at
some point in their lives. Back pain is well established as one of the most common reasons
for seeking care from a medical doctor. The American public also turns to alternative
medicine providers, such as doctors of chiropractic, for back pain care. However, few
clinical examples and little scientific evidence exist of care coordination between these two
provider groups in general, and none that specifically target older adults above the age of
65. The purpose of the Collaborative Care for Older Adults with Back Pain (COCOA) Clinical
Trial is to evaluate the clinical effectiveness and feasibility of a collaborative care model
(medical and chiropractic care) through a pragmatic, prospective pilot trial conducted with
120 older adults over the age of 65 with low back pain of at least 1 month duration.
Participants will be randomized to 3-parallel treatment arms: a) conventional medical care
(MED CARE), b) unlinked conventional medical and chiropractic care (DUAL CARE), and c) a
co-management model including conventional medical and chiropractic care (SHARED CARE).
Participants in all three groups will receive up to 12 weeks of usual back pain treatment
from medical doctors or doctors of osteopathy (MD/DO) at Genesis Family Medical Center.
Participants in two treatment groups additionally will receive up to 12 weeks of usual
chiropractic care for back pain from doctors of chiropractic at the Palmer Research Clinic.
Outcomes including pain, disability and secondary outcomes will be measured at 1, 2, and 3
months (primary endpoint) with follow-up assessments completed by telephone at 6, 9, and 12
months.

Inclusion Criteria:

- Age 65 years or older

- Low back pain ≥4 on the 11‐point Numerical Rating Scale

- Low back pain diagnosis consistent with Quebec Task Force (QTF) Classifications 1‐9

- Ambulatory mobility status per successful completion of the Timed Up & Go Test

- Willingness to participate in this clinical trial regardless of treatment group
assignment

Exclusion Criteria:

- No history or current episode of low back pain

- Low back pain duration of less than 1 month

- Low back pain diagnosis consistent with Quebec Task Force Classification of 10 or 11

- Any healthcare provider treatment for low back pain in past 2 months

- Currently seeking or receiving compensation for a work‐related injury or personal
injury case for low back pain

- Currently seeking or applying for disability payments for any health condition

- Spine or neck surgery in the past 3 months

- Broken bone in any location in the body in the past 6 weeks

- Active carcinoma/metastatic disease or current treatment for any form of cancer

- Aortic aneurysm (or suspicion of) >5cm

- Serious concomitant illness or co‐morbidity

- Alcohol or drug abuse or dependence

- Need for laboratory testing, diagnostic imaging beyond plain film x‐rays or referral
to a healthcare provider not associated with the study to determine a diagnosis or for
necessary treatment

- Activities of daily living (ADL), mobility impairment or sensory impairment that
impacts safety

- Cognitive or memory impairment

- Compliance concerns

- Nursing home residence

- No reliable transportation

- Plans to move from Quad‐Cities in the next 4 months

- Pregnancy or plans to become pregnant in next 4 months in a female participant

- Enrollment in this study by another individual who currently lives in the same
household as the participant

- Inability to speak (verbally comprehend), read or write in English language

- Unwillingness to avoid all forms of low back pain treatment from non‐study medical
doctors and chiropractors during study participation

- Unwillingness to enroll in clinical trial regardless of treatment group assignment

- Unwillingness to sign informed consent document

- Current student, employee or faculty member of the Palmer College of Chiropractic or
Genesis Family Medical Center