Improving Access to Chiropractic Care for Low Back Pain in Underserved Primary Care Settings: Development and Evaluation of a Multi-level Implementation Strategy - PROJECT SUMMARY
Background: Low back pain (LBP) is common, disabling and costly. Recent American College of Physicians
guidelines recommend nonpharmacologic treatments (e.g., spinal manipulation, heat, massage, and
acupuncture) as safe and effective first-line approaches for LBP. However, these treatments are most
commonly provided to middle- to high- income predominantly white communities, with limited access for low
income racially-diverse patients. Chiropractic care, which includes spinal manipulation, is a prototypical
example of this care gap; few doctors of chiropractic (DCs) are integrated into medical settings, and primary
care providers (PCPs) rarely refer to community-based DCs. Goals and Objectives: Dr. Roseen’s long-term
career objective is to become an independent investigator studying the effectiveness and implementation of
LBP treatments for underserved populations. This K23 career development award will allow Dr. Roseen to gain
advanced skills in conducting pragmatic clinical trials that can assess the real-world effectiveness of LBP
treatments and to become competent in the development and assessment of implementation strategies.
Career Development Activities: The K23 application will provide structured didactic and hands-on training
that will build on Dr. Roseen’s training in chiropractic and epidemiology, through experience and education in
process mapping, qualitative methods, implementation strategies, outcome measurement in pragmatic trials,
and advanced statistical analyses. The plan will engage Dr. Roseen in robust training activities including
mentorship, coursework, research projects, publishing and presenting, workshops and seminars, grant-writing,
and responsible conduct of research. Mentors: Dr. Roseen’s mentorship team consists of accomplished
scientists from clinical research, health services research, epidemiology, biostatistics, medical anthropology,
implementation science, and primary care. Environment: Dr. Roseen will benefit from a comprehensive
research training program based at Boston University (BU), Boston Medical Center, BU Clinical Epidemiology
Research and Training Unit, BU Center for Improvement and Implementation Science, and BU Clinical and
Translational Science Institute. Research: Dr. Roseen’s proposed K23 research project will address the limited
availability of nonpharmacologic treatments, using chiropractic care as an exemplar, in primary care settings.
Dr. Roseen will first engage key stakeholders through process mapping and analysis (Aim 1a). Secondly,
qualitative methods will be used to identify facilitators and barriers of PCP-DC referrals (Aim 1b). He will then
design and pilot a multi-level implementation strategy in three community health centers based in underserved
neighborhoods in Boston (Aim 2). This award will prepare Dr. Roseen to submit a future competitive grant
application for a multi-site hybrid implementation and effectiveness trial of chiropractic care for LBP in
underserved communities.
