Table 4.

Joint display of quantitative and qualitative survey results: Canadian military Veterans’ most preferred health care providers for managing chronic low back pain

Quantitative results	Representative quotations	Meta-inferences
Registered massage therapist (seen at any time for LBP treatment, 74%, median satisfaction with care, 8/10, seen on base for LBP treatment during military career, 9%, seen off base for LBP treatment during military career, 30%, should be available on base for active duty military personnel, 70%)	Pain relief “I find massage to be one of the most helpful things I have ever done to help with chronic pain.” (R285) “Registered massage therapist [ranks highest] because they can help loosen tension and swelling [in] areas to give me temporary pain reduction and [this] adds to my quality of life.” (R47) “Massage is one of the only providers to remove chronic pain even if it is short-lived relief.” (R108) Limited or no access to treatment “Not sure what the military’s concern is with massage therapy, but they definitely need to have it as a treatment option. Their excuse of ‘physiotherapists can do some massage’ is not an adequate replacement of RMTs or their services.” (R287) “Treatments should be available other than PT on and off base. There is no one solution to back pain and various avenue[s] should be explored.” (R102)	Registered massage therapy was ranked by Veterans as their most preferred health care discipline for managing chronic low back pain. This treatment approach was perceived by Veterans to give effective (yet short-term) pain relief and was the top low back pain treatment service Veterans felt should be available on base for active duty military personnel.
Physiotherapist (seen at any time for LBP treatment, 79%, median satisfaction with care, 7/10, seen on base for LBP treatment during military career, 58%, seen off base for LBP treatment during military career, 39%, should be available on base for active duty military personnel, 60%)	Treatment effectiveness vs. no benefit or relief “The physiotherapist was able to effectively treat my condition and showed me how to strengthen and maintain my core muscularity to support my lower back.” (R340) “The pain changes places and the physio[therapist] knows exactly what to do to reduce the pain. He also uses dry needles and moist heat.” (R81) “Physio[therapy] is good for keeping certain areas strengthened. For example, the stabilizing muscles.” (R32) “The physiotherapy provided by the base physiotherapist was always inadequate, consisting of TENS and ultrasound treatments only.” (R207) “The physio[therapist] was seen a few times on the base, but I didn’t get any benefit from it.” (R81) “Lately I’ve seen a physio[therapist] who does dry needles and it’s much more effective than the ‘standard’ physio[therapy].” (R271)	Physiotherapy was ranked by Veterans as their second most preferred health care discipline for managing chronic low back pain. Veterans felt these services should be accessible to active duty military personnel; however, many indicated that they accessed these (and other) services off base while in the military because of inadequate or ineffective treatment.
Family doctor or GP (seen at any time for LBP treatment, 87%, median satisfaction with care, 6/10, seen on base for LBP treatment during military career, 64%, seen off base for LBP treatment during military career, 18%, should be available on base for active duty military personnel, 46%)	Treatment effectiveness and practitioner trust “My doctor is great. I feel that she has really given me a lot of time. And has prescribed as I need meds.” (R110) “A family doctor [is most important to me] because they can monitor situations and order scans, X-rays or tests as required and they can refer me to the massage therapist annually for insurance coverage.” (R47) “[I am] fortunate to have a family doctor that also was a military doctor and knew what we did in the medical trade.” (R72) Lack of empathy or understanding “My treatment through the military — family doctor — was very negative in the treatment of my back pain.” (R11) “There are no family doctors on base, you see military doctors and PAs so you don’t receive the care you need. They just give you Motrin (400 mg) [and] tell you it’s just muscle aches and send you back to work.” (R314)	Family medicine was ranked by Veterans as their third most preferred health care discipline for managing chronic low back pain. Veterans perceived the GP as someone they trust and who manages their primary care needs. Several Veterans were dissatisfied, however, with the medical care they received on base in the military for low back pain treatment.
Chiropractor (seen at any time for LBP treatment, 70%, median satisfaction with care, 6/10, seen on base for LBP treatment during military career, 13%, seen off base for LBP treatment during military career, 35%, should be available on base for active duty military personnel, 51%)	Pain relief and competency “Chiro[practic] is [my most preferred treatment] because it provides instant pain relief.” (R51) “Chiro[practic treatment] would, at times, hurt like hell but the releases were definitely worth it.” (R377) “[The] chiropractor knows the bones of the spine/lower back and can usually determine if there is a problem.” (R18) Limited or no access to treatment “Only [the] chiro[practor]’s treatments were approved and you had to drag the devil by the tail to get them. I was allowed to get treatments at the chiro[practor] only when I was in crisis and not for maintenance.” (R81) “I ended up paying out of pocket for chiropractic care near the end of my military career. At that point, I needed to ‘invest’ in myself/my body since the military wasn’t taking care of me.” (R367)	Chiropractic was ranked by Veterans as their fourth most preferred health care discipline for managing chronic low back pain. More than half of respondents felt these services should be available on base for active duty military personnel, citing immediate pain relief and spine care expertise as common reasons. Access to these services was limited in the military.

LBP = low back pain; R = respondent; RMT = registered massage therapy/therapist; PT = physiotherapy; TENS = transcutaneous electrical nerve stimulation; GP = general physician; PA = physician assistant.