Assessment of Chiropractic Treatment for Low Back Pain and Smoking Cessation in Military Active Duty Personnel. (No)

• Numerical pain rating scale Roland Morris Disability Questionnaire [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
  Volunteers will be asked to rate their level of pain on that day on an ordinal 11-box scale (0=no LBP; 11=worst LBP possible) at baseline and at all of the follow-up assessments. The NRS has excellent metric properties, is easy to administer and score, and has received much use in LBP research. Pain data will be collected at baseline and at all endpoint visits. The question will capture information pertaining to pain over the last 24 hours.
  
  

• Title: Back Pain Functional Scale Title: Back Pain Functional Scale [ Time Frame: Time Frame: at baseline and at all endpoint visits (week 2, week 4, week 6, week 12) ] [ Designated as safety issue: No ]
  It measures back functioning
  
  

• Bothersomeness of Symptoms [ Time Frame: at baseline and at all endpoint visits (week 2, week 4, week 6, week 12) ] [ Designated as safety issue: No ]
  The bothersomeness of symptoms commonly associated with LBP will be measured using an existing measure from the LBP literature. Bothersomeness questions are practical and have demonstrated good internal consistency, construct validity, and responsiveness to change with time in patients with LBP and sciatica.
  
  
• PROMIS-29 [ Time Frame: week 6 and week 12 ] [ Designated as safety issue: No ]
  Patient Reported Outcomes Measurement Information System (PROMIS) was a recently developed scoring system consisting of a battery of assessment tools that measure patient-reported health status.
  
  
• Healthcare Utilization & Medication Use [ Time Frame: at baseline and at all endpoint visits (week 2, week 4, week 6, week 12) ] [ Designated as safety issue: No ]
  Based on the pilot study, volunteers will most likely have been seen by other healthcare providers and prescribed pain medication by a primary care provider prior to being enrolled in the study, this questionnaire will ensure that we collect all healthcare and medication use.
  
  
• Tobacco Use [ Time Frame: at baseline and at all endpoint visits (week 2, week 4, week 6, week 12) ] [ Designated as safety issue: No ]
  The level of tobacco dependence will be evaluated as in Fagerstrom & Schneider.
  
  
• Tobacco Dependence [ Time Frame: at baseline and at all endpoint visits (week 2, week 4, week 6, week 12) ] [ Designated as safety issue: No ]
  
• Patient Satisfaction / Global Improvement [ Time Frame: at week 2, week 4, and week 6 ] [ Designated as safety issue: No ]
  
• Patient Expectation [ Time Frame: Baseline only ] [ Designated as safety issue: No ]
  Previous work has shown that patient expectation regarding benefit of care can be a significant non-specific effect.
  
  

Low back pain (LBP) is the most common cause of disability worldwide, but it is even more prevalent in active duty military personnel; more than 50% of all diagnoses resulting in disability discharges from the military across all branches are due to musculoskeletal conditions. LBP has been characterized as "The Silent Military Threat" because of its negative impact on mission readiness and the degree to which it compromises a fit fighting force. For these reasons, military personnel with LBP need a practical and effective treatment that relieves their pain and allows them to return to duty quickly, but also one that preserves function and military readiness, addresses the underlying causes of the episode and protects against re‐injury. Currently a clear "gold standard" medical treatment for low back pain does not exist and studies show that evidence‐based guidelines are rarely used in general practice. Thus, there is a need to consider innovative treatment options for chronic diseases such as LBP. Therefore the primary purpose of this study is to assess the effectiveness of chiropractic manipulative therapy (CMT) for pain management and improved function in active duty service members with orthopedic injuries or disorders of the low back that do not require surgery. This multi‐site Phase II Clinical Comparative Effectiveness Trial is designed to rigorously compare the outcomes of CMT and conventional medical care (CMC) to CMC alone. Chiropractic treatment will include CMT plus ancillary physiotherapeutic interventions. CMC will be delivered following current standards of medical practice at each site. At each of the four participating sites, active military personnel, ages 18‐50, who present with acute, sub‐acute or chronic low back pain that does not require surgery will be randomized to one of the two treatment groups. Outcome measures include the Numerical Rating Scale for pain, the Roland‐Morris Low Back Pain and Disability questionnaire, the Back Pain Functional Scale for assessing function, and the Global Improvement questionnaire for patient perception regarding improvement in function. Patient Expectation and Patient Satisfaction questionnaires will be used to examine volunteer expectations toward care and perceptions of that care. Pharmaceutical use and duty status data will also be collected. The PROMIS-29 will be utilized to compare the general health component and quality of life of the sample at baseline. In addition, doctors of chiropractic are well positioned to provide information to support tobacco cessation. Thus this clinical trial will include a nested study designed to measure the impact of a tobacco cessation program delivered by a doctor of chiropractic. The results from this randomized clinical trial, with a nested tobacco cessation intervention, will provide critical information regarding the health and mission‐support benefits of chiropractic health care delivery for active duty service members in the military