ACERF Funded Grants

Project title: A feasibility study for integrating physical and psychological care for persistent low back pain in primary care.

Grant: $19,997

Investigators: Dr David McNaughton (School of Psychological Sciences and Department of Chiropractic, Macquarie University), Professor Simon French (Department of Chiropractic, Macquarie University), Professor Mark Hancock (Department of Health Professions, Macquarie University), Professor Blake Dear (School of Psychological Sciences, Macquarie University), Dr Alana Fisher (School of Psychological Sciences, Macquarie University) and Professor Michael Jones (Faculty of Medicine, Health and Human Sciences, Macquarie University).

Project summary: Low back pain (LBP) pain is the number one cause for disability globally and this burden is expected to increase with an aging population. Many individuals with LBP respond well to primary care interventions; however, reflective of a biopsychosocial framework, there is a proportion of individuals with persistent LBP who require additional psychological therapy. This psychologically informed approach to care for individuals with persistent LBP is recommended in national and international clinical guidelines, however it is rarely provided and often unavailable within chiropractic practice. Therefore, we propose to test a promising model of care for individuals with persistent LBP that provides immediate access to a psychologically based and internet-delivered pain management intervention in addition to usual care from musculoskeletal clinicians, particularly chiropractors. We hypothesise that this approach will be sustainable, scalable, enhance clinical outcomes, is economically efficient, improve access to healthcare resources, and increase the capacity of the health system to deliver multidisciplinary care.The aim of this program of research is to give every patient with persistent LBP the opportunity to experience psychologically informed and multi-disciplinary care from every chiropractor in Australia and represents a simple and effective solution for MSK clinicians who treat complex and persistent LBP. Whilst guidelines consistently recommend multi-disciplinary and psychologically informed care for persistent LBP, the integrated availability of these services at a primary care level is uncommon. Outcomes of this program of research aims to determine the acceptability and usefulness of eHealth psychological pain management programs integrated into primary MSK care, particularly chiropractic practices. This will position chiropractors as an integral component to the evidence based and multidisciplinary management of chronic pain in Australia.

Project title: Measurement of HVLA-SMT in the management of upper quadrant musculoskeletal pain in young adults: a feasibility study

Grant: $17,733

Investigators: Dr Aron Downie (Department of Chiropractic, Macquarie University), Associate Professor Michael Swain (Department of Chiropractic, Macquarie University), Dr Benjamin Brown (Department of Chiropractic, Macquarie University), Dr Martha Funabashi (Canadian Memorial College of Chiropractic), Mr David Starmer (Canadian Memorial College of Chiropractic) and Mr Luke Ross (Department of Chiropractic, Macquarie University).

Project summary: This study aims to investigate the feasibility of implementing High-Velocity Low-Amplitude Spinal Manipulative Therapy (HVLA-SMT) as a treatment method for young adults with Upper Quadrant Musculoskeletal Pain (UQMP) in an Australian chiropractic setting. UQMP is a prevalent condition among young adults, leading them to seek healthcare. Current evidence-based management for UQMP emphasises patient-centred approaches, including addressing biomechanical and psychological barriers, exercise prescription, and manual therapy. Chiropractors often employ thoracic HVLA-SMT as part of a multi-modal approach for UQMP, but the factors influencing its effectiveness remain unclear.

Additionally, the relationship between force-time characteristics of HVLA-SMT and clinical outcomes is not well understood. Challenges include limited research, lack of standardised reporting, limited access to force sensing technology, and research protocols that do not reflect clinical practice.

This study employs a mixed-methods observational approach to assess the feasibility of recording HVLA-SMT force-time characteristics and capturing candidate prognostic factors in young adults with UQMP. Data collection includes pain, kinesiophobia, depression/anxiety/stress scores, and disability indices. Clinical data includes pre/post-SMT and HVLA-SMT force-time profiles. Feasibility outcomes include enrolment rates, participation and dropout rates, and patient comfort level during HVLA-SMT. Qualitative assessments will explore expectations, satisfaction, impact on treatment, perceived differences compared to regular appointments, and attitudes toward data collection.

To better comprehend how SMT functions in real clinical practice, it is crucial to adopt a pragmatic approach where SMT is integrated into a comprehensive treatment plan that mirrors routine patient care. This approach would allow for the collection of data over an extended period, better reflecting the long-term effects observed in actual clinical practice without disrupting patient encounters. Furthermore, if clinical investigations can capture SMT force-time characteristics seamlessly as part of routine practice, it has the potential to enhance patient management and treatment outcomes in the real world.

Project title: Vestibular rehabilitation and manual therapy intervention in the management of mild traumatic brain injury: a pilot randomised controlled trial

Grant: $19,998

Investigators:  Dr Carlo Rinaudo (Director, The Brain Hub), Dr Roger Engel (Department of Chiropractic, Macquarie University) and Dr Reidar Lystad (Australian Institute of Health Innovation, Macquarie University).

Project summary: Traumatic brain injury (TBI) is usually caused by a blow to the head or a violent shaking of the head and body. A range of events including sporting activities can result in mild traumatic brain injury (mTBI). Despite an increase in the number of mTBIs, there has been no substantial change in functional outcomes post-mTBI in recent years. Most patients with mTBI recover within a few weeks. However, a proportion have persistent symptoms including visual dysfunction, sleep disturbance, fatigue, headaches, neck pain, dizziness, and balance problems. These symptoms are characterised as post-concussion syndrome (PCS) when they last longer than four weeks post-injury.

Standard care for PCS includes exercise. Evidence also exists for the use of vestibular rehabilitation and manual therapy on patients with PCS. Notwithstanding, there is a gap in the evidence regarding the effect of combining vestibular rehabilitation or manual therapy with exercise. The aim of this study is to assess the feasibility of administering exercise with vestibular rehabilitation or manual therapy to adults with sport-related PCS.

Feasibility will be assessed by collecting data on recruitment and attrition rates, adherence and tolerance to interventions, and adverse events. It is expected that the results of this study will show that it is feasible to administer a combination of exercise and vestibular rehabilitation or manual therapy to people with sports-related PCS and that the combination of interventions has the potential to deliver greater improvements in vestibular and physical function, pain, sleep and quality of life, compared to exercise alone.

The significance of these expected outcomes is that it increases the level of knowledge around mobilisation and manipulation of the neck and spine in an evidence-informed manner. It also raises the potential for expanding chiropractic research and practice in the field of PCS, which is currently undergoing a paradigm shift from passively awaiting symptom remission to recommending active management.

Project title: Cross-cultural adaptation, validation, and responsiveness of the English version of the Young Spine Questionnaire (YSQ) and Young Disability Questionnaire – Spine (YDQ-S) in adolescents aged 13–18 years

Grant: $19,833

Investigators: Associate Professor Michael Swain (Department of Chiropractic, Macquarie University), Professor Lise Hestbæk (University of Southern Denmark), Associate Professor Henrik Lauridsen (University of Southern Denmark), Dr Benjamin Brown (Department of Chiropractic, Macquarie University), Ms Nichole Phillips (Department of Chiropractic, Macquarie University), Dr Amy Miller (AECC University College), Professor Katie Pohlman (Parker University), Ms Isabelle Bogard (University of Sydney, Nepean Blue Mountains Local Health District), Dr Tiê Parma Yamato (University of Sydney, Nepean Blue Mountains Local Health District) and Professor Steve Kamper (University of Sydney, Nepean Blue Mountains Local Health District).

Project summary: Spinal pain becomes societies’ leading cause of years lived with disability at the end of adolescence and adolescent spinal pain is likely to continue into adulthood. Despite this, there is a striking paucity of spinal pain research conducted among adolescents. Suitable instruments that measure the burden of spinal pain in a valid and reliable manner are essential prior to the development and testing of therapies, however few instruments exist for schoolchildren with spinal pain. The Young Spine Questionnaire (YSQ) and the Young Disability Questionnaire – Spine (YDQ-S) were developed to fill this void. For Danish speaking children and adolescents with spinal pain, these instruments measure prevalence, frequency, intensity, and consequences of spinal pain.

Our study builds on work of Danish chiropractors. We aim to: (1) cross-culturally adapt; (2) test construct validity and test-retest reliability; and (3) assess the construct responsiveness of the YSQ and YDQ-S in Australians aged 13–18 years.

The Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) guidelines will be followed, including their general recommendations for the design of studies on instrument measurement properties in addition to the criteria in our specific aims.

This project builds on prior chiropractic research, providing a necessary step to allow the use of the YSQ/YDQ-S in Australia and similar English-speaking countries. In Australia and elsewhere, health services utilisation research shows that adolescents with spinal pain represent the largest proportion of paediatric chiropractic care seekers. However, there is a paucity of research evidence to inform chiropractors, patients, caregivers, and the community about the consequential impacts of spinal pain in adolescents. To bridge this knowledge gap and improve patient care, it is imperative to develop a valid, reliable, and responsive questionnaire, specifically tailored for adolescents. This questionnaire can serve as an invaluable tool for chiropractors and other healthcare professionals, enabling them to effectively identify, address and assess the precise consequences of spinal pain among adolescents seeking their care.

Project title: The Logan Indigenous Chiropractic Outreach Program: Enhancing Indigenous health outcomes and clinical chiropractic training

Grant: $28,709

Investigators: Dr David McNaughton, Logan Indigenous Elders from the Logan District Aboriginal and Torres Strait Islander Corporation for Elders, A/Professor Katie De Luca, Dr Matt Fernandez, Dr Thomas Doering (Central Queensland University), Professor Markus Melloh (Queensland University of Technology).

Project summary: Indigenous Australians report a higher prevalence of musculoskeletal pain and are less likely to access healthcare compared to non-Indigenous Australians. Indigenous Australians cite cultural barriers, such as poor communication, as the main reason they choose not to access care. Therefore, understanding how and why successful, Community-led healthcare clinics operate is imperative to achieve equity in health outcomes for Indigenous Australians.

The Logan Indigenous Chiropractic Outreach Program (LICOP) is an established and successful Community-led partnership between the Logan District Elders and CQUniversity, operating since August 2023. This student outreach program was developed in response to Community needs and has provided more than 600 chiropractic consultations to over 100 patients, with demand continuing to grow.

This project aims to understand Indigenous patient experiences and health outcomes at the LICOP. Specifically, it will explore patient experiences by identifying barriers and facilitators to chiropractic care and determine the sociodemographic characteristics and musculoskeletal symptoms of Indigenous patients accessing the service.

By understanding how this Community-led model operates, the project aims to inform culturally appropriate, safe, and responsive healthcare delivery for Indigenous Australians. Findings will provide an evidence base to improve musculoskeletal healthcare, support equity in health outcomes, and strengthen partnerships between chiropractic services and Indigenous communities.

Project title: Paramedic beliefs toward back pain and appropriate referral pathways: a pre-post measurement study

Grant: $28,665

Investigators: Dr Simon Vella, Dr Gustavo Machado, Professor Chris Maher, A/Professor Christina Abdel-Shaheed (Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney), A/Professor Michael Swain (Macquarie University), A/Professor Paul Simpson (Western Sydney University), Dr Kimberley Davis, Mr Christopher Smith (NSW Ambulance).

Project summary: Back pain is a common presentation to ambulance services globally. In Australia, paramedics manage back pain more often than they manage cardiac arrest, though ambulance services provide little to no guidance to paramedics to manage this condition. Paramedics often manage people with back pain without sufficient education and training, which leads to an escalation of care. In most instances, patients are transported to the emergency department where they are more likely to receive costly low-value care such as hospital admission, imaging and opioid medicines.

There is currently no research evaluating paramedic beliefs toward the management of back pain and appropriate referral pathways to manage this condition. Better paramedic education and training could ensure more appropriate ambulance dispatch, treatment and referral to community health services such as chiropractic.

This project aims to evaluate paramedic beliefs toward the management of back pain and the effectiveness of an educational intervention, including knowledge of appropriate alternate referral pathways. The intervention will include an e-learning module and in-person training aligned with the Australian Low Back Pain Clinical Care Standards, with a focus on improving urgent care and referral in the community to services such as chiropractic.

By improving paramedic knowledge and beliefs, this study aims to support more appropriate management of back pain, reduce unnecessary hospital presentations, and improve referral to community-based care. The findings will provide a foundation for improving care pathways and strengthening connections between ambulance services and community health services, including chiropractic.

Project title: Expanding Chiropractic Horizons: A Feasibility Study on Integrating Chiropractors into Advanced Tertiary Spine Care Teams in Australia

Grant: $30,190

Investigators: Professor Rosemary Giuriato, Miss Annie Young, Mr Chris Agius, Mr Christopher Burrell, A/Professor Irina Dedova, Dr Stephanie Marhoff-Beard, Dr Stephney Whillier, Dr Benjamin Brown, Dr Aron Downie, Professor Simon French, A/Professor Hazel Jenkins, A/Professor Michael Swain (Department of Chiropractic, Macquarie University), Assistant Professor Carlo Ammendolia (Institute of Medical Sciences, University of Toronto; Director of the Spine Clinic and the Spinal Stenosis Program at the Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto), A/Professor Rikke Krüger Jensen (University of Southern Denmark), Dr Prashanth Rao (Macquarie University Hospital; School of Clinical Medicine, UNSW).

Project summary: Lumbar spinal stenosis (LSS) is managed by chiropractors integrated in tertiary care networks in North America and Europe, but not Australia. This project addresses a gap in the Australian healthcare system: the lack of structured, evidence-based conservative care for LSS within integrated health centres. LSS is a leading cause of pain and disability in older adults, and its incidence is expected to rise with population ageing. Although clinical guidelines recommend conservative care before surgical intervention, access to integrated non-operative programs remains limited, contributing to variable surgical rates and delays in optimal management. The LSS Boot Camp program has demonstrated significant improvements in walking ability, pain, and function, yet the program has not been tested in Australia.

This feasibility study will be conducted at MQ Health’s Chiropractic Clinic, located adjacent to the university’s private hospital, specialty consulting rooms, and outpatient services. This setting provides opportunity to integrate chiropractic-led LSS Boot Camp within MQ Health, enabling collaboration with specialists and bidirectional referral pathways.

The study aims to: (1) assess feasibility outcomes following a 6-week structured program; and (2) identify barriers and facilitators to program implementation and integration, informing a future controlled trial and a new workforce pathway for chiropractors in advanced spine care.

Project title: Chiropractic Outcomes for Psychological Health, Empowerment, and Burnout: The COPE-Burnout Study

Grant: $48,424

Investigators: Dr David McNaughton (School of Medical Health and Applied Sciences, CQ University), Dr Matthew Coleshill (Black Dog Institute; Faculty of Medicine and Health, UNSW), Dr Melissa Black (Black Dog Institute; Faculty of Psychology, UNSW), Dr Aron Downie (Department of Chiropractic, Macquarie University), A/Professor Katie de Luca, Dr Matthew Fernandez, Professor Tania Signal (School of Medical Health and Applied Sciences, CQ University).

Project summary: The sustainability of healthcare systems depends on a well-supported, mentally healthy workforce. Chiropractors, like other health professionals, are vulnerable to mental health challenges and burnout, which are key contributors to job dissatisfaction, medical errors, and workforce attrition. Despite this, little is known about the mental health status of Australian chiropractors as well as their access to, and evaluation of, effective psychological support. Previous research from more than 200 chiropractors and chiropractic students has suggested trends towards high rates of psychological distress (21%), burnout (33%), and suicidal ideation (12%).

This project aims to: (i) identify the prevalence of, and factors associated, with mental health difficulties and burnout among Australian chiropractors, and (ii) evaluate the acceptability and preliminary outcomes of a blended and psychologically informed digital program for health professional burnout – navigating burnout.

Findings will inform targeted, scalable interventions to enhance mental health support, reduce stigma, and foster long-term workforce retention. This evidence will provide a foundation for policy and service delivery strategies to promote sustainable models of care that prioritise clinician wellbeing within the chiropractic profession.

Project title: Early detection of cancer in people with spine pain

Grant: $11,000

Investigators: Dr Aron Downie (Department of Chiropractic, Macquarie University), Dr Casper Nim (University Hospital of Southern Denmark; University of Southern Denmark), A/Professor Hazel Jenkins, A/Professor Michael Swain (Department of Chiropractic, Macquarie University), Professor Jan Hartvigsen (University of Southern Denmark), A/Professor Mette Wod (Odense University Hospital), Dr Pradeep Virdee, Professor Clare Bankhead, Dr Cynthia Wright Drakesmith (University of Oxford).

Project summary: Some patients with back or neck pain (spinal pain) might have undiagnosed cancer, which can have catastrophic effects on health. Chiropractors and other musculoskeletal clinicians currently lack dependable tools to identify cancer when patients present with spinal pain. This research aims to develop tools to improve the clinical diagnosis of cancer in people with spinal pain, thereby empowering clinicians to make timely decisions in patient care.

The project will identify patient characteristics associated with cancer by hypothesising that specific clinical features can predict cancer diagnosis in certain patients, enabling the development of new tools to assist clinicians in raising suspicion of cancer diagnosis. Currently, no data exists in Australia to achieve these research aims. The project will use routinely collected clinical data from The Spine Centre of Southern Denmark (an outpatient clinic), which is very similar to that collected in Australian chiropractic practice.

The results of this research will benefit both patients and chiropractors through more accurate and timely cancer diagnoses. This unique opportunity will support early, less invasive care with better health outcomes. Additionally, clinicians will be better equipped to decide when referral for further diagnostic workup is appropriate, potentially saving on healthcare expenditure without compromising the quality of care.