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J Manipulative Physiol Ther. 2019 Jun 26. pii: S0161-4754(18)30364-6. doi: 10.1016/j.jmpt.2019.02.006. [Epub ahead of print]

Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input.

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RAND Corporation, Health, Santa Monica, California.
RAND Corporation, University of California Los Angeles, Southern California Health Sciences, Santa Monica, California. Electronic address:
David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Deloitte Consulting LLP, Los Angeles, California.



The purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.


We conducted focus groups, cognitive interviews, a literature review of measures in prior chiropractic and complementary and integrative health research, and a pilot study to develop questionnaires of patient preferences, experiences, values, and beliefs.


Questionnaires were administered online to 2024 individuals from 125 chiropractic clinics. The survey included 3 long questionnaires and 5 shorter ones. All were administered online. The baseline items had 2 questionnaires that respondents could complete in different sittings. Respondents completed shorter biweekly follow-ups every 2 weeks and a final questionnaire at 3 months. The 2 initial questionnaires had 81 and 140 items, the 5 biweekly follow-up questionnaires had 37 items each, and the endline questionnaire contained 121 items. Participants generally responded positively to the survey items, and 91% of the patients who completed a baseline questionnaire completed the endpoint survey 3 months later. We used "legacy" measures, and we also adapted measures and developed new measures for this study. Preliminary assessment of reliability and validity for a newly developed scale about coping behaviors indicates that the items work well together in a scale.


This article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.


Chiropractic; Chronic Pain; Complementary Therapies; Low Back Pain; Neck Pain; Pain; Surveys and Questionnaires


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