Table 1.

Chiropractic Treatment Frequency and Duration

Recommended Chiropractic Treatment Frequency and Duration for VA Patients With Spine-Related Symptoms
Type of Case	Maximum Visits to Reach Initial Minimum Clinically Important Improvement	Subsequent Visits to Reach Additional Clinically Important Improvement	No Further Improvement (Resolved or Patient Plateaus With Residual Symptomsa)
Acute episode, uncomplicated	≤6 visits within 3 wkb	≤4 visits within 3 wk	Endpoint of trial of chiropractic care
Acute episode, complicated	≤6 visits within 3 wkb	≤6 visits within 3 wk	Endpoint of trial of chiropractic care
Chronic condition	≤8 visits within 6 wk	≤4 visits within 4 wk	Endpoint of trial of chiropractic care
Definitions
Minimum clinically important improvement: The threshold of a beneficial patient-oriented change that can be ascribed to treatment effects. Objective measures of such are a decrease of ≥2 points on the NPRS, and/or a decrease in ≥10 points on the Oswestry Disability Questionnaire, and/or similar improvement on other comparable outcome measures.
Complicated case: Presence of one or more of the following: severe pain (8, 9, or 10 on NPRS); history of ≥4 prior episodes; pain duration N8 days; structural pathology/anomaly; relevant comorbid conditions.
Chronic condition: Condition that has been present for >3 mo and typically has failed other treatment approaches.

Source. Chiropractic Field Advisory Committee, 2013.³²

NPRS, numerical pain rating scale; VA, Department of Veterans Affairs.

^aAdditional chiropractic manipulative therapy or other palliative/supportive care for pain management may be indicated for patients with chronic conditions whose function decreases and/or pain increases after a withdrawal of chiropractic care. This added course of chiropractic management may be appropriate for patients engaged in active care strategies, if other indicated medical and psychosocial treatment options have been considered and/or included in the overall VA pain management plan.

^bIf there has been no reasonable benefit within the initial treatment plan period, continuation of chiropractic manipulative therapy requires a substantial change in treatment plan