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Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial

Christine M Goertz1*, Stacie A Salsbury1, Robert D Vining1, Cynthia R Long1, Andrew A Andresen2, Mark E Jones2, Kevin J Lyons3, Maria A Hondras1, Lisa Z Killinger4, Fredric D Wolinsky5 and Robert B Wallace5

Author Affiliations

1 Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA

2 Genesis Quad Cities Family Medicine Residency Program, 1345 W. Central Park Ave, Davenport, IA, 52804, USA

3 Thomas Jefferson University Center for Collaborative Research, 720 Edison, 130 S. 9th St, Philadelphia, PA, 19107, USA

4 Department of Diagnosis and Radiology, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA

5 The University of Iowa College of Public Health, S161 CPHB, 101 River St, Iowa City, IA, 52242, USA

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Trials 2013, 14:18  doi:10.1186/1745-6215-14-18

Published: 16 January 2013



Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults.


This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content analysis of clinical trial notes.


This pragmatic, pilot randomized controlled trial uses a mixed method approach to evaluate the clinical effectiveness, feasibility, and participant and provider perceptions of collaborative care between medical doctors and doctors of chiropractic in the treatment of older adults with low back pain.

Trial registration

This trial registered in on 04 March 2011 with the ID number of NCT01312233.

Aged; Chiropractic; Education; Professional; Electronic health records; Family practice; Integrative medicine; Interprofessional relations; Low back pain; Therapy