Management of Operation Iraqi Freedom and Operation Enduring Freedom Veterans in a Veterans Health Administration Chiropractic Clinic: A Case Series

Article excerpt

BACKGROUND

Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans are a priority population for the Veterans Health Administration (VHA) [1]. From October 2001 through December 2008, approximately 981,834 OIF/OEF veterans have left Active Duty and become eligible for VHA benefits and services [2]. Reports depict that 498,737 OIF/OEF veterans received VHA benefits and services in fiscal year (FY) 2008 [3] and approximately 425,538 have received VHA healthcare [2]. The two most frequent diagnoses seen in this group are musculoskeletal system and connective tissue disorders (International Classification of Diseases-10th Edition [ICD-10] 710-739; seen in 50.0% of cases) and mental disorders (ICD-10 290-319; seen in 45.6% of cases) [2]. Multiple diagnoses per individual are common.

Chiropractic services are a novel introduction to VHA [4]. In response to Public Law 107-135, VHA established chiropractic clinics at 26 facilities beginning late 2004. Without further mandate, from FY2005 to FY2008, the number of clinics increased from 26 to 36 (38%) and the number of veterans seen at these clinics increased from more than 4,000 to more than 13,000 (225%).

As specified by VHA Directive 2004-035, VHA provides chiropractic services for management of musculoskeletal conditions. Current evidence suggests that spinal manipulation, a central component of chiropractic treatment, may provide benefit in some cases of low back and neck pain [5-6].

Since spinal pain complaints are common in OIF/OEF veterans [7-8], some of these patients are likely receiving care at VHA chiropractic clinics. However, no data have been published on chiropractic services for OIF/OEF veterans. Furthermore, since these patients have not been represented in previous clinical trials of spinal manipulation and may have unique health needs, the role of chiropractic management in such cases is unknown.

Given that OIF/OEF veterans are a priority population for VHA and that chiropractic care is a novel introduction to VHA's services, an understanding of the intersection of these two phenomena may be of interest. Thus, the purpose of this study is to describe select processes and outcomes of care for a group of OIF/OEF veterans seen at one VHA chiropractic clinic.

METHODS

This study is a retrospective review of consecutive cases. An administrative specialist searched the Department of Veterans Affairs Connecticut Healthcare System's (VACHS's) electronic scheduling database to identify all new patient consultations to the VACHS chiropractic clinic over a 6-month period (November 1, 2007, to April 30, 2008). This date range was chosen so that the most recent case included would have initiated care at least 3 months before the start of this study (August 1, 2008). A research assistant cross-referenced this list with the Computerized Patient Record System to identify the subset of OIF/OEF veterans. I verified the OIF/OEF status of the cases and performed the data extraction and analysis. All cases that completed consultation and at least one follow-up visit were included.

All patients received usual and customary chiropractic management as typically delivered at the VACHS clinic; no experimental protocol was used.

This study describes the following features of the included cases:

1. Patient pretreatment characteristics.

a. Demographics.

* Age.

* Sex.

* Consulting service.

b. Clinical presentation.

* Reason for seeking care.

* Duration of complaint.

* Mechanism of onset.

* Pain intensity at presentation.

* Prior treatment.

* Comorbid posttraumatic stress disorder (PTSD).

2. Elements of chiropractic management.

a. Examination procedures and findings.

b. Interventions.

3. Outcomes.

a. Adverse events.

b. …