The Danish Chiropractic low back pain Cohort (ChiCo)
The ChiCo cohort includes comprehensive patient reported and clinician reported information on adults seeking care for back pain and standardised coding of images from a subsample examined with radiographs or MRI scans. Frequent follow-ups are conducted during 1 year after inclusion. Based on the data from the cohort we will investigate the value and effects of imaging in primary care back pain patients, the importance of health beliefs, reasons for care seeking, the validity of existing predictive models and the potential for early identification of people at risk for long-term sick leave.
One in six Danes suffers from back pain, 20% of all sick days in Denmark are due to LBP, and it is the most frequent reason for care seeking. National clinical guidelines support non-pharmalogical interventions such as manual therapy and supervised exercises. However, we have surprisingly little insight into who seeks this type of care, how other co-morbidities influence prognosis and treatment effects, and how important aspects of the clinical consultation such as preconceived ideas about the condition (including beliefs about imaging and treatments) affect the clinical course. Moreover, we know little about the extent to which guidelines on imaging are implemented and to which extent imaging informs and affects care for back pain.
RCTs are not well suited to answering these important clinical questions and it has been proposed that large scale cohorts in spine pain should be a research priority.
The ChiCo cohort will register data from a large group of LBP patients (n=5000) from Danish chiropractic clinics that will create the basis for answering a range of research questions. The main research focus will be on LBP but questions related to other musculoskeletal complaints in people with LBP can also be addressed.
Pre-planned research projects include investigating:
- The profile of chiropractic patients, their clinical course and prognosis
- The prognostic value of radiographic findings in patients with low back pain
- Illness belief, expectations and clinical decision making in chiropractic practice
- The validity of existing low back pain prediction models
- The validity of previously identified back pain trajectories
Description of the cohort
Patients above 18 years of age consulting chiropractors with a primary complaint of low back pain.
Patients should consult with a new episode of back pain (defined as not having initiated a course of chiropractic care prior to inclusion).
To be included patients need to understand and read Danish and have access to e-mail and SMS.
Participants are recruited from private chiropractic practices in the Central Denmark Region.
Data and biological material
Patient reported questionnaires include information about sociodemographic factors, pain, activity limitation, work, psychological factors and general health.
Participants are surveyed at the time of the first consultation and after 2 weeks, 3 months and 12 months. In addition they are followed by SMS at 34 time points during 12 months.
Clinician reported items, at the first visit, include clinical examination findings, red flags and indications for imaging registered.
Findings on imaging in the subgroup of patients who have imaging are systematically coded.
Collaborating researchers and departments
Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) and Department of Sports Science and Clinical Biomechanics, SDU
- Senior Researcher Alice Kongsted
- Klaus Doktor
Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) and the Spine Centre of Southern Denmark
- Senior Researcher Tue Secher Jensen
Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB)
- CEO Henrik Wulff Christensen
- Orla Lund Nielsen
Department of Sports Science and Clinical Biomechanics, SDU
Department of Sports Science and Clinical Biomechanics, SDU and Curtain University, Perth, Australia
Macquarie University, Sydney, Australia
- Associate Professor Mark Hancock
Queen's University, Kingston, Canada
- Research Professor Simon French
Erasmus MC, Department of General Practice, Rotterdam, The Netherlands
George Institute of Global Health, Sydney, Australia
EMGO, Amsterdam, The Netherlands
Keele University, UK
- Professor Danielle van der Windt
Publications associated with the project
Simonsen, Gitte D. MSc, Public Health*; Jensen, Tue S. PhD*,†,‡; Kongsted, Alice PhD*,† Reassuring Patients With Low Back Pain in Primary Care Consultations, The Clinical Journal of Pain: August 2021 - Volume 37 - Issue 8 - p 598-606 doi: 10.1097/AJP.0000000000000946
Kongsted A, Nielsen OL, Christensen HW, Hartvigsen J, Doktor K, Kent P, Jensen TS. The Danish Chiropractic Low Back Pain Cohort (ChiCo): Description and Summary of an Available Data Source for Research Collaborations. Clin Epidemiol. 2020 Oct 2;12:1015-1027. doi: 10.2147/CLEP.S266220. PMID: 33061649; PMCID: PMC7537847.
Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study. Chiropr Man Therap. 2021 Nov 23;29(1):46. doi: 10.1186/s12998-021-00403-3. PMID: 34814923; PMCID: PMC8611826.
Kongsted A, Jensen TS, Doktor K, Hestbæk L. Effects of weekly pain monitoring on back pain outcomes: a non-randomised controlled study. Chiropr Man Therap. 2021 Sep 16;29(1):37. doi: 10.1186/s12998-021-00393-2. PMID: 34530882; PMCID: PMC8444569.