title: Effectiveness and economic evaluation of chiropractic care for the treatment of low back pain: a systematic review protocol.
abstract: BACKGROUND
  Chiropractic care is a common treatment for low back pain (LBP). Previous studies have failed to clarify the relative cost-effectiveness of chiropractic care in comparison with other commonly used approaches because previous attempts to synthetize the economic literature has only included partial economic evaluations. The objective of this project is to estimate the clinical effectiveness and cost-effectiveness of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP.
  
  
  METHODS
  Two systematic reviews will be conducted to identify 1) randomized controlled trials and 2) full economic evaluations of chiropractic care for low back pain compared to standard care provided by other healthcare providers. We will conduct searches in specialized electronic databases for randomized controlled trials and full economic evaluations published between 1990 and 2014 using a combination of keywords and MeSH terms. This will be supplemented by a search of the gray literature. Citations, abstracts, and relevant papers will be screened for eligibility by two reviewers independently. Studies will be critically appraised using 1) the Cochrane risk of bias tool and 2) the Drummond (BMJ) checklist. Results will be summarized using Slavin's qualitative best-evidence synthesis approach. Data relating to the primary outcomes of the effectiveness study will be evaluated for inclusion in meta-analyses. The costs will be standardized to the same currency (USD) and adjusted to the same year for inflation. The incremental cost-effectiveness, incremental net benefit, and relevant confidant intervals will be recalculated in order to facilitate comparison between studies.
  
  
  CONCLUSIONS
  Our review will evaluate both the clinical effectiveness and the cost-effectiveness associated with chiropractic care for LBP. A more precise estimate of the cost-effectiveness of chiropractic care for LBP relative to other forms of conservative care is needed for decision-makers and third-party payers to offer best care options for LBP. Our results will facilitate evidence-based management of patients with LBP and identify key areas for future research.
  
  
  BACKGROUND
  The protocol is registered on PROSPERO ( CRD42014008746 ).
authors: Public Health PhD Program, School of Public Health, University of Montreal, 7101 Parc avenue, Montreal, QC, H3N 1X9, Canada. marc-andre.blanchette@umontreal.ca.
authors: Marc-André
authors: MA
authors: Blanchette
authors: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada. andre.bussieres@mcgill.ca.|Centre de Recherche Interdisciplinaire en Réadaptation de Montréal, 7005 Maisonneuve Boulevard West, Montreal, QC, H4B 1 T3, Canada. andre.bussieres@mcgill.ca.|Département chiropratique, Université du Québec à Trois-Rivières, 3351 Des Forges Boulevard, Trois-Rivières, QC, G9A 5H7, Canada. andre.bussieres@mcgill.ca.
authors: André
authors: A
authors: Bussières
authors: Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230, Odense M, Denmark. m.jensen@nikkb.dk.
authors: Mette Jensen
authors: MJ
authors: Stochkendahl
authors: McGill University, 809 Sherbrooke Street West, Montreal, QC, H3A 0C1, Canada. jill.boruff@mcgill.ca.
authors: Jill
authors: J
authors: Boruff
authors: McGill University, 809 Sherbrooke Street West, Montreal, QC, H3A 0C1, Canada. pamela.harrison@mcgill.ca.
authors: Pamela
authors: P
authors: Harrison
mesh_terms: D002684:Chiropractic / Q000191:economics; D002985:Clinical Protocols; D000529:Complementary Therapies / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D012107:Research Design; D000078202:Systematic Reviews as Topic