So, you’re interested in pursuing training and/or employment in a hospital system? Welcome to the small, but growing, number of chiropractic students and providers who likewise possess this aspiration. In order to function effectively in team-based environments such as medical centers or outpatient clinics, it is likely beneficial to understand what other members do. This may be accomplished a number of ways. One option is through postgraduate training programs such as the Veterans Affairs or Aurora Health Care Chiropractic Integrated Clinical Practice Residencies, which provide trainees with opportunities to rotate through various medical and surgical specialties, observing first-hand how these providers operate in the spine care domain.
Alternatively–or perhaps supplementary–to this, individuals who are interested in exploring integrated opportunities may benefit from “pre-reading” to become familiarized with collaborative care processes, core competencies, and specialty parlance prior to engaging in formal training or employment. Consequently, what follows is an aggregated, non-exhaustive list of important open access publications which may prove useful in preparing students and providers to thrive in these settings.
Interprofessional Collaboration:
1. An overview of the medical specialties most relevant to chiropractic practice and education (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958654/)
This study descriptively explored the medical and surgical specialties most pertinent to general chiropractic practice and education. It serves as an excellent primer to the specialties an integrated chiropractor is likely to interact with on a regular basis.
2. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process (https://pubmed.ncbi.nlm.nih.gov/29482827/)
This consensus study developed an integrated care pathway for chiropractors, primary care providers, and mental health professionals to guide the management of veterans with low back pain. It provides a standardized approach to interdisciplinary referral in an integrated healthcare setting and may assist chiropractors in decision making, communication, and referral processes within these types of systems.
3. Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team (https://pubmed.ncbi.nlm.nih.gov/29977521/)
This qualitative study investigated the planned integration of a chiropractor into a multidisciplinary team in a rehabilitation specialty hospital. It reports a conceptual model of professional and personal qualities preferred in a chiropractor by various stakeholders in a collaborative healthcare setting.
Guideline-Based Care:
4. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings (https://www.ncbi.nlm.nih.gov/books/NBK599212/)
5. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (https://pubmed.ncbi.nlm.nih.gov/28192789/)
These guidelines present evidence and provides recommendations on the noninvasive treatment of low back pain. They furnish an overview of both pharmacologic and non-pharmacologic treatment options. As it is common for chiropractors to co-manage spine patients in integrated settings, these publications highlight common treatment approaches.
Invasive Spine Procedures:
6. Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604560/)
7. Low Back Pain: Current Surgical Approaches (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522460/)
These studies reviewed common procedures performed by interventional pain physicians and spine surgeons, respectively, along with adjunctive visuals. Chiropractors operating in integrated settings will likely receive and send referrals to these physicians and hence should be well acquainted with both the basic and advanced invasive approaches for spine pain. Students and providers may also find it useful to supplement these papers with recorded demonstrations or animations of spinal procedures available on video sharing platforms.
Chiropractic Core Competencies:
8. International Framework for Red Flags for Potential Serious Spinal Pathologies (https://pubmed.ncbi.nlm.nih.gov/32438853/)
This paper presents a pragmatic framework for clinicians to screen for serious spinal pathologies that may mimic musculoskeletal conditions. Chiropractors must be able to effectively and efficiently coordinate care in an integrated setting when “red flags” are evident.
9. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach (https://pubmed.ncbi.nlm.nih.gov/29034802/)
This clinical commentary presents an updated comprehensive model and narrative appraisal of the literature exploring the mechanisms through which manual therapy interventions inhibit pain. It is probable that chiropractors engaged in integrated settings will be asked by other healthcare providers about the modern understanding of how manual therapies achieve pain-related outcomes.
10. The association between cervical artery dissection and spinal manipulation among US adults (https://pubmed.ncbi.nlm.nih.gov/37422607/)
This case-control study used health claims data to evaluate the current evidence related to spinal manipulative therapy and cervical artery dissection. As arguably one of the most controversial topics among spine care professionals, chiropractors aspiring to integrated healthcare settings must be equipped to navigate this topic with authority and nuance.
Dr. Schut is the 2023-2024 chiropractic resident at the VA Connecticut Healthcare System (West Haven, Conn.).
Disclaimer: The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of Veteran’s Affairs or U.S. Government.
