Chiropractic Practice in Military & Veterans’ Health Care

Joe Keating, Jr., PhD Friend Teacher Mentor Chiropractic historian Memorial 31 Jan 2008

Chiropractic Practice in Military & Veterans’ Health Care

Contributors Bart Green, DC, MSEd Claire Johnson, DC, MSEd Naval Medical Center San Diego Claire Johnson, DC, MSEd So Cal University of Health Sciences National University of Health Sciences Anthony Lisi, DC VA Connecticut Healthcare System

Background Active duty Veterans Approximately 100 DCs working Health care benefit for 12 years 49 military treatment facilities Veterans Health care benefit for 3 years 29 veteran treatment facilities Approximately 100 DCs working Expansion taking place

Purpose Summarize the literature that describes chiropractic practice, utilization, and policy in active duty and veteran health care environments Improve health care for beneficiaries Guide integration and expansion efforts Identify areas for future research Identify the current evidence base Provide guidance for administrators

Methods Searched MEDLINE, CINAHL, ICL Through March 2007 ‘Chiropractic’ + list of relevant terms Looked through references Inclusion: All languages, all designs Excluded: Non-peer reviewed, non-operating situations, non-DoD/VA Consensus of all authors

Search Term Examples chiropractic + military chiropractic + navy chiropractic + sailor chiropractic + marines chiropractic + marine chiropractic + Department of Defense chiropractic + Department of Veterans Affairs chiropractic + veterans chiropractic + veteran alternative medicine + military complementary medicine + military

MEDLINE Search CINAHL Search ICL Search Search Terms Total Hits Potentially Relevant Hits New Hits chiropractic + military 10 7 54 3 26 4 chiropractic + navy 1 chiropractic + sailor chiropractic + marines chiropractic + marine 2 chiropractic + Department of Defense 53 5 chiropractic + Department of Veterans Affairs 6 chiropractic + veterans 9 68 12 chiropractic + veteran alternative medicine + military 11 17 complementary medicine + military TOTAL 25

Results 30 articles met inclusion criteria 26 articles excluded 4 articles reviewed 1 description of how a VA clinic runs and description of student intern program 1 practice demographic report 1 comparison of DoD vs non-DoD student interns 1 case report

Results Dunn A. Chiropractic internship program in the DVAHCS. J Chiropr Educ 2005. Description of student intern training program integrated in VA: no program evaluation Description of how clinic functions Identifies similar programs at 2 DoD hospitals

Results Dunn et al. Chiropractic consultation requests in the VAHCS. J Manipulative Physiol Ther 2006. Retrospective chart review First 100 consultation requests submitted to 1 VHA chiropractic clinic Quality improvement measures made to improve consults in integrative environment Description of clinic operations, access to care, origin of consults Patient demographics

Results Dunn. DoD chiropractic internships: a survey of internship participants and nonparticipants. J Chiropr Educ 2006 Survey of graduates who had completed a DoD student internship vs those who had not Null hypothesis accepted No difference in income, job satisfaction, demographics

Results Green et al. Use of conventional and alternative treatment strategies for a case of low back pain in a F/A-18 aviator. Chiropr Osteopath 2006 Described coordinated multidisciplinary treatment (including chiro) of a Marine pilot with acute LBP

Discussion Paucity of publications 50% report on education in VA/DoD Little to inform practice Need more to inform health care policy Clinical research non-existent Based on publications, chiropractic does not exist in the DoD or VA Much more could be done to report on integration with other health care disciplines

Why so few? No dedicated time for research/scholarship Most DCs not trained to do any research, even a case report Most not trained to write Research time not encouraged/recognized Barriers to contractors bringing in research $

Potential Solutions Provide research training Provide authorship training Build collaborations for contractors to bring research funding into the military/VA hospital Negotiate scholar-practitioner positions within the VA and DoD 50% time research Trained candidates w/track records

VA Progress Research efforts in progress Funded VA Intramural (Dougherty) HRSA (Dougherty) In review VA Intramural (Lisi) Efforts underway to assess current research capacity of VA DCs Build culture of research and train clinicians Research experience part of VA DC qualifications Those w/research track records may be strong candidates for future positions

Conclusion Small, but growing, descriptive evidence base to support those working in this environment Efforts should be focused on clinical research for DoD/VA patient populations and research related to the integration and implementation of chiropractic services