The long-term objective of this project is to prepare the applicant to become an independent clinical research scientist investigating the clinical and cost effectiveness of spinal manipulation therapy (SMT) for neck and back pain conditions. Brent Leininger, DC, practiced as a chiropractor for three years. He is participating in a bridge fellowship program at Northwestern Health Sciences University (NWHSU), which readies CAM practitioners to pursue research careers. Dr. Leininger's primary sponsor is Dr. Gert Bronfort at Northwestern Health Sciences University, an established clinical researcher in SMT for neck and back pain conditions. During the fellowship period Dr. Leininger will participate in practical research training, formal coursework, and a research project. Practical research experience will be gained through rotations at Dr. Bronfort's clinical research center (Wolfe-Harris Center for Clinical Studies), which will include clinical application of inclusion/exclusion criteria, applicaion of SMT in clinical research, statistical analyses/interpretation, and scientific writing. Collaboration with health economists (co-sponsor Dr. McDonough, consultants Drs. Tosteson and Nyman) at the Dartmouth Institute and the University of Minnesota (U of M) will provide practical research training and mentorship related to the conduct of economic evaluations alongside randomized trials. Formal coursework in clinical and cost effectiveness research at the University of Minnesota will culminate in a Master's of Science degree in Clinical Research and will complement the practical learning experiences. Through the proposed research project, Dr. Leininger will be among the first to assess the economic value of SMT in seniors with chronic neck pain from a societal perspective. Study subjects were those enrolled in his primary sponsor's study (R18HP01425). The applicant's project has three Specific Aims which are complementary to the parent trial and will include an estimation of the cost effectiveness of SMT versus supervised exercise and home exercise for chronic neck pain in seniors using pain, quality-adjusted life years, and disability outcomes over a one-year follow-up period. Through a structured three year training plan, Dr. Leininger will acquire new skills in clinical research of SMT for neck and back pain conditions, as well as cost effectiveness data collection and analytic techniques. This will be fostered by individualized mentorship provided by Dr. Bronfort and co-sponsors (Drs. Evans and McDonough). NWHSU and the University of Minnesota are well suited for the applicant's training and include a CAM focused clinical research center and an NIH affiliated CTSA (1UL1RR033183).

Public Health Relevance

Neck pain is a common and costly condition and is particularly concerning for senior populations already burdened with other health complaints. CAM interventions, such as spinal manipulation, have shown promise in younger populations. This research project will address the cost-effectiveness of spinal manipulation for chronic neck pain in seniors.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZAT1-PK (21))
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Khalsa, Partap Singh
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Northwestern Health Sciences University
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Evans, Roni; Haas, Mitchell; Schulz, Craig et al. (2018) Spinal manipulation and exercise for low back pain in adolescents: a randomized trial. Pain 159:1297-1307
Leininger, Brent; McDonough, Christine; Evans, Roni et al. (2016) Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain. Spine J 16:1292-1304
Weeks, William B; Leininger, Brent; Whedon, James M et al. (2016) The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities. J Manipulative Physiol Ther 39:63-75.e1-2
Rhee, Taeho Greg; Leininger, Brent D; Ghildayal, Neha et al. (2016) Complementary and integrative healthcare for patients with mechanical low back pain in a U.S. hospital setting. Complement Ther Med 24:7-12
Haas, Mitchell; Br√łnfort, Gert; Evans, Roni L et al. (2016) Spinal rehabilitative exercise or manual treatment for the prevention of cervicogenic headache in adults. Cochrane Database Syst Rev 2016:
Leininger, Brent; Br√łnfort, Gert; Haas, Mitchell et al. (2016) Spinal rehabilitative exercise or manual treatment for the prevention of tension-type headache in adults. Cochrane Database Syst Rev 2016:
Weeks, William B; Tosteson, Tor D; Whedon, James M et al. (2015) Comparing Propensity Score Methods for Creating Comparable Cohorts of Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare Patients With Chronic Low Back Pain. J Manipulative Physiol Ther 38:620-8
Schulz, Craig; Leininger, Brent; Evans, Roni et al. (2014) Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial. Chiropr Man Therap 22:21
Leininger, Brent D; Evans, Roni; Bronfort, Gert (2014) Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain. J Manipulative Physiol Ther 37:593-601
Leininger, Brent D; Kamper, Steven J (2013) No strong evidence that the addition of joint mobilisation to an exercise programme improves outcomes for shoulder dysfunction. Br J Sports Med :