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Observational Study
. 2024 May 15;19(5):e0303651.
doi: 10.1371/journal.pone.0303651. eCollection 2024.

Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers

Claire E O'Hanlon  1   2 , Steven B Zeliadt  3   4 , Rian DeFaccio  3 , Lauren Gaj  5 , Barbara G Bokhour  5   6 , Stephanie L Taylor  1   7   8
Affiliations
Observational Study

Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers

Claire E O'Hanlon et al. PLoS One. .

Abstract

Background: Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers.

Materials and methods: We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics.

Results: In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191).

Conclusions: Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient flow diagram.
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References

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Publication types

Grants and funding

This evaluation was funded as a quality improvement project by the Office of Patient Centered Care and Cultural Transformation and VA QUERI program (PEC 13-001, PI: BGB), https://www.queri.research.va.gov/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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