170045 Relationship between posttraumatic stress disorder and clinical outcomes within a Veterans Affairs medical center chiropractic clinic

Monday, October 27, 2008: 9:30 AM

Andrew S. Dunn, DC, MEd, MS , Chiropractic Clinic, VA of Western New York, Buffalo, NY
Steven R. Passmore, DC, MS , New York Chiropractic College, Seneca Falls, NY
Jeanmarie Burke, PhD , New York Chiropractic College, Seneca Falls, NY
Objectives: With the integration of chiropractic services into the Veterans Affairs (VA) Health Care System, there is a need for preliminary observational research to determine the impact of veteran patient characteristics on chiropractic clinical outcomes for musculoskeletal (MSK) pain complaints.

Methods: Retrospective review of clinical outcomes was completed for 130 veteran patients with either neck (n=28) or low back (n=102) complaints as determined from region-specific questionnaires (Revised Oswestry Disability Questionnaire or Neck Disability Index). Secondary analyses of the potential relationships between clinical outcomes and age, gender, body mass index (BMI), service connected (SC) disability, MSK SC disability, Posttraumatic Stress Disorder (PTSD), treatment number, and baseline outcomes were performed.

Results: Including neck and low back complaints, the mean score improvement for veteran patients was 8.05 points (95% CI=6.24,9.86) (t129=8.77, P<0.001) equating to 17.7% change from baseline. The change in outcomes was independent of age, gender, BMI, SC disability, MSK SC disability, and treatment number. There was a statistically significant negative correlation between baseline outcome scores and raw score improvement (r=-0.18, P<.05). Patients with PTSD (n=21) experienced a mean score improvement of 3.38 (CI=-1.5,8.3) points compared to patients without PTSD (n=109) who experienced a mean score improvement of 8.95 (CI=7.0,10.9) points (t128=2.27, P=0.025).

Conclusion: While the etiology is unclear, PTSD may impact chiropractic management of MSK pain complaints in a VA patient population. Prospective clinical research designs need to address the potential contributions of PTSD on chiropractic clinical outcomes in this unique patient population.

Learning Objectives:
1) Identify two patient demographic characteristics that may impact chiropractic clinical outcomes in veteran patients. 2) Define Post-traumatic Stress Disorder (PTSD). 3) Discuss the nature of service connected (SC) disability for veteran patients and the potential role of compensation-seeking behaviors on improvement with respect to self-reported outcome measures.

Keywords: Veterans' Health, Chiropractic

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: It represents original research conducted at the VA of Western New York. I serve as the principle investigator for this work which has been approved through the local VA R&D & IRB Committees.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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