Integrative care for the management of low back pain: Use of a clinical care pathway

Michele J. Maiers, Kristine K. Westrom, Claire G. Legendre, Gert Bronfort

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background. For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial. Methods. A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study. Results. Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans. Conclusion. This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting. Trial registration. NCT00567333.

Original languageEnglish (US)
Article number298
JournalBMC Health Services Research
StatePublished - 2010
Externally publishedYes

Bibliographical note

Funding Information:
The authors would like to acknowledge Greg Angstman, MD, for his expertise in the development of healthcare teams and group dynamics and the training he conducted with the integrative care team and case managers. This project is supported by funds from the Department of Health and Human Services HHS), Health Resources and Services Administration HRSA), Bureau of Health Professions (BHPr), Division of Medicine and Dentistry DMD) under grant number R18HP07639, Individualized Chiropractic and Integrative Care for Low Back Pain. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the U.S. government, HHS, HRSA, BHPr, or the DMD.


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