Chiropractic and Exercise Management of Spinal Dysfunction in Seniors

Interventions that temper declining functional status due to aging are critical to the
vitality and longevity of the elderly. Conservative, non-drug treatments that address
disability and pain may significantly reduce the societal burden associated with spinal
dysfunction in this population. Chiropractic and exercise are two such promising therapies,
and have yet to be compared in the context of short- versus long-term management.

Unanticipated recruitment challenges and repeated reductions to the award negatively
impacted our ability to implement the study as proposed. After careful deliberation among
the study's Steering Committee, and approval by the IRB and funding agency, the study has
been modified to a 2-treatment comparison (formerly 3 treatments).

As such, the primary aim of this study is to compare the effectiveness of 3 versus 9 months
of chiropractic care and exercise in 200 seniors with chronic spinal dysfunction. The
primary outcomes are patient-rated neck and back disability.

Additionally, initial inclusion criteria regarding disability ratings have been relaxed to
allow more individuals with global spine-related disability to qualify. Specifically,
participants now must have:

1. a minimum of 10% disability in both neck and back regions (at least 5/50 on Neck
Disability Index (NDI) and Oswestry Disability Index(ODI)) at baseline 1 evaluation,
and

2. a combined disability (NDI+ODI) score of at least 25/100 at baseline 1 evaluation.

Secondary aims are to assess between-group differences in patient self-reported pain,
general health, improvement, self-efficacy, kinesiophobia, satisfaction, medication use, and
objective biomechanical outcomes. Seniors' perceptions and experience with treatment will be
assessed through qualitative interviews. Finally, the cost-effectiveness and cost-utility of
these interventions will be measured.

Additional secondary aims include assessing within group differences in an additional 18
patients randomized to receive 9 months of exercise only in the earlier phase of this study.
Outcomes of these aims include the self-report, biomechanical, and qualitative outcomes
listed above (with the exception of cost-effectiveness and cost-utility data).

This project will significantly contribute to the evidence base of conservative, non-drug
treatments that address disability and pain in seniors with spinal dysfunction.
Identification of effective therapies has tremendous potential to substantially improve the
functional status, quality of life, and overall health in the aging population.

Inclusion Criteria:

- 65 years of age and older

- independent ambulation and community dwelling

- stable medication plan

- neck-related disability (minimal score of 10% on Neck Disability Index)

- back-related disability (minimal score of 10% on Oswestry Disability Index)

- minimum combined disability score (above) of 25% at first baseline screening

- at least 12 week duration of neck and back related disability

Exclusion Criteria:

- moderate or severe cognitive impairment

- untreated clinical depression

- surgical spinal fusion or multiple incidents of spinal surgery

- contraindications to spinal manipulation or exercise

- ongoing, non-pharmacological treatment for a spinal condition