Short summary

In the current study, we will investigate and evaluate the possibilities for systematically collecting patient-reported data from chiropractic practice, evaluating patient yields in three treatment packages and attempt to uncover any implementation barriers in the chiropractors. In addition, we will investigate if patients with lumbar spinal stenosis seen in chiropractic practice will benefit from a 6-week pragmatically-individualised treatment program called "The Boot Camp Program".

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Rationale

Disc herniation in the neck or low back is a condition, which in some patients may affect one or more nerves in the cervical or lumbar spine causing arm or leg pain. Disc herniations are treated in chiropractic practice according to current clinical guidelines and patients are typically included in a structured treatment package of approximately 8 weeks. Although the prognosis for disc herniation is usually good, very little is known about patients with disc herniations treated in chiropractic practice.

Lumbar spinal stenosis is a common degenerative spinal condition that can cause significant pain and disability leading to dramatically reduced quality of life, immobility and functional limitation. Lumbar spinal stenosis is a condition where osteoarthritis in the spine causes narrowing of the spinal canal. In some people, the decrease in the total area of the spinal canals can lead to compression of the associated neurovascular structures and inflammation of soft tissue structures causing neurogenic claudication, which is the main symptom of lumbar spinal stenosis and described as lower limb pain and neurological symptoms increased by walking and relieved by sitting or bending forward.

A new clinical guideline from the Danish Health Authority deals with patients with lumbar spinal stenosis and points out that the existing literature is very sparse and therefore recommends more research in this area. In chiropractic practice, patients with lumbar spinal stenosis are included in a treatment package of up to 12 weeks. Although the care package provides an overall structure, there is a lack of knowledge about the treatment modalities and patient outcomes.

The "Boot Camp Program" is a 6-week pragmatically-individualised treatment program that includes joint mobilisation, stretching techniques and soft tissue treatment, as well as exercise and training. Previous studies from Canada have shown that the treatment program can increase patients' walking distance and their physical level of functioning and relieve pain.

In the current study, we wish to investigate and evaluate the possibilities for systematically collecting patient-reported data from chiropractic practice, evaluate patient outcomes in the three treatment packages (lumbar spinal stenosis, cervical or lumbar nerve root compression) and uncover implementation barriers of treatment packages in the chiropractors. In addition, we wish to investigate whether it is possible to apply a treatment concept like the "Boot Camp Program" to Danish conditions, and if patients with lumbar spinal stenosis seen in chiropractic practice, will benefit from the program.

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Description of the cohort

The cohort consists of approximately 4500 patients presenting in chiropractic clinics with a new episode of either cervical or lumbar nerve root compression or with symptoms suggesting lumbar spinal stenosis. Patients will be age 18 or older and be able to read and answer questionnaires in Danish. In addition, 50 patients with lumbar spinal stenosis, confirmed by MRI, will be included in a case-series with treatment ad modum "Boot Camp Program". 

Data and biological material

Data will include patient reported information on symptoms, physical function, sociodemographic data, self-reported health, psychological factors such as anxiety and depression, expectations for treatment and course of symptoms. Narrative reports of lumbar MRI and data from walking test will be collected from the 50 patients included in the case-series. In addition, patients will be followed weekly using SMS-Track providing information on pain and sick leave.

Patient reported information will be collected at baseline and up to 5 follow-ups within the first year. 

Collaborating researchers and departments

Nordic Institute of Chiropractic and Clinical Biomechanics and Institute of Regional Health Science, University of Southern Denmark

• Senior researcher and clinical ass. Prof. Rikke Krüger Jensen, PhD, CandManu

Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark

• Managing Director Henrik Wulff Christensen, PhD, MD, DC
• Data Manager Orla Lund Nielsen