title: Chiropractic care of musculoskeletal disorders in a unique population within Canadian community health centers.
abstract: OBJECTIVE
  This study was part of a larger demonstration project integrating chiropractic care into publicly funded Canadian community health centers. This pre/post study investigated the effectiveness of chiropractic care in reducing pain and disability as well as improving general health status in a unique population of urban, low-income, and multiethnic patients with musculoskeletal (MSK) complaints.
  
  
  METHODS
  All patients who presented to one of two community health center-based chiropractic clinics with MSK complaints between August 2004 and December 2005 were recruited to participate in this study. Outcomes were assessed by a general health measure (Short Form-12), a pain scale (VAS), and site-specific disability indexes (Roland-Morris Questionnaire and Neck Disability Index), which were administered before and after a 12-week treatment period.
  
  
  RESULTS
  Three hundred twenty-four patients with MSK conditions were recruited into the study, and 259 (80.0%) of them were followed to the study's conclusion. Clinically important and statistically significant positive changes were observed for all outcomes (Short Form-12: physical composite score mean change = 4.9, 95% confidence interval [CI] = 3.8-6.0; VAS: current pain mean change = 2.3, 95% CI = 1.9-2.6; Neck Disability Index: mean change = 6.8, 95% CI = 5.4-8.1; Roland-Morris Questionnaire: mean change = 4.3, 95% CI = 3.6-5.1). No adverse events were reported.
  
  
  CONCLUSIONS
  Patients of low socioeconomic status face barriers to accessing chiropractic services. This study suggests that chiropractic care reduces pain and disability as well as improves general health status in patients with MSK conditions. Further studies using a more robust methodology are needed to investigate the efficacy and cost-effectiveness of introducing chiropractic care into publicly funded health care facilities.
authors.affiliation: Carlington Community and Health Services, Ottawa, Ontario, Canada. michaelgarner@gmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Garner
authors.forename: Peter
authors.initials: P
authors.lastname: Aker
authors.forename: Jeff
authors.initials: J
authors.lastname: Balon
authors.forename: Michael
authors.initials: M
authors.lastname: Birmingham
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Dirk
authors.initials: D
authors.lastname: Keenan
authors.forename: Pran
authors.initials: P
authors.lastname: Manga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D003151:Community Health Centers / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000628:therapy*; D010147:Pain Measurement; D011203:Poverty; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014505:Urban Population