The American Chiropractic Association (ACA) Council on Chiropractic Pediatrics (CCP) is participating in an international study that seeks to fill knowledge gaps in research relating to pediatric chiropractic treatment. The COURSE Study is the first study to focus on the clinical course of spinal pain in adolescents presenting to primary care. Researchers in Australia and the United States are currently testing the feasibility of a larger study, investigating the logistics of recruiting and following adolescent patients who seek chiropractic care.
According to chief investigators of the COURSE Study, Michael Swain, PhD, MPhil, MChiroprac, FRCC, and North America Lead Investigator and ACA member Katherine Pohlman, DC, MS, PhD, adolescents are an important but overlooked group in musculoskeletal research. Spinal pain has significant impacts on young people, including school absences, impaired social functioning, restriction of daily activities and more.
“They don’t always seek care because their pain is typically transient,” Dr. Pohlman explained. “It’s not something that’s taken very seriously in this age group.”
Drs. Pohlman and Swain began collaborating during their time as inaugural fellows in the Chiropractic Academy for Research Leadership (CARL) program, which aims to facilitate collaboration, mentoring, leadership development and networking among early-career chiropractic researchers. He asked her to join a grant to look at adolescent spinal pain. Since then, the COURSE Study has expanded to include researchers from Canada and the United Kingdom, as well.
“Adolescents are a tough population to recruit into studies,” Dr. Pohlman said. “This research can’t be done in one area. It needs to be an international effort to be successful. We really feel, with the three continents and four countries, that if we find this feasible, we could be part of filling this gap in spinal pain research.”
COURSE Study Recruiting U.S. Chiropractors
In the U.S., the COURSE Study is still seeking participants — any doctor of chiropractic who treats spinal pain in patients aged 12-17 is encouraged to join. Participating DCs are asked to screen patients for eligibility and invite them to enroll in the study. A research coordinator will train doctors and be available to answer questions throughout the process.
At a baseline visit with a participating patient, both the doctor and the patient will complete an electronic baseline survey covering prognostic factors such as sociodemographic characteristics; pain and physical functioning; emotional and social functioning; health behavior; and clinical findings. From this point, care progresses as normal for a three-month period. Over the course of the three months, the study’s automated database will send patients weekly text messages to monitor spinal pain and recovery. At the end of this period, chiropractors and patients will complete the final follow-up measures electronically.
“When the chiropractors are excited about the research and encourage their patients to complete the study’s survey, we get a great response rate. Patients want to give back to the person helping them so much,” Dr. Pohlman said. “This study is not just for the chiropractic profession — this is filling a knowledge gap in the spinal pain literature. When DCs share this with their patients, they reciprocate the excitement to try to help the next generation.”
Jessie Young, DC, the research director for the CCP, hopes that this study will provide a better understanding of the onset of spinal pain in adolescents. “We know that kids with back pain turn into adults with back pain,” she said. “We want to see what that first episode looks like.” Participating in this study is also a great opportunity for chiropractors to gain insight into the research process. Dr. Pohlman states that participating DCs will “get up close and personal” with study protocols and data collection. “To be directly involved with the data collection of a research study and then to see the manuscript, knowing how your data contributed, can be a huge learning opportunity,” she said.
The next step for the COURSE team is to seek funding for a larger scale study. The CCP was involved in initial fundraising efforts for the feasibility study, which Dr. Pohlman says was invaluable to obtaining additional international funding. “When the larger study is funded, this will be the first of its kind, and the fact that it’s being led by chiropractors is pretty awesome,” she said.
Photo by João Rabelo