Integrative Care

Use of Integrative Care by Veterans/Military

  • A 2019 study of veterans found that in the past year 52% used any Complementary/Integrative Health (CIH) approach; 44% massage therapy, 37% chiropractic, 34% mindfulness, 24% other meditation, and 25% yoga. Pain and stress reduction/relaxation were the two most frequent reasons for using them.1
  • In a 2019 study of veterans with MSK pain, 27% of younger veterans used some type of CIH. CIH use was more common among women, single patients, and those with multiple comorbidities.2
  • A 2018 study developed an integrated care pathway for DCs, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities.3
  • A 2018 study described characteristics of veterans using CIH practices, which were used by half the sample. Use of manual therapies (chiropractic, acupuncture, physical therapy, massage) was associated with chronic pain and female sex.4
  • A 2018 study described the use of CIH in the Military Health System.5

Chiropractic in Multidisciplinary Settings

  • A 2018 study of inpatients who received multidisciplinary rehab care that included chiropractic. Typically, chiropractic is not offered in such settings. It required modifications of the typical delivery of chiropractic care due to patients having significant functional limitations and comorbidity.6
  • A related study described professional qualities chiropractors showed that enhanced patient outcomes and interprofessional teamwork.7
  • A 2018 survey described 50 DCs working in private sector integrated health care facilities. Most respondents were men with a mean 21 years of experience in chiropractic working in hospitals (40%), multispecialty offices (21%), ambulatory clinics (16%), or other (21%) health care settings. Most (68%) were employees and received salary compensation (59%). More than 60% reported co-management of patients with medical professionals.8
  • This 2017 study described patients seeking chiropractic, acupuncture, or massage therapy in a dedicated Center for Complementary Medicine (CCM) within an Integrated Health Care Delivery System. Spine/truncal pain was the most common complaint and chiropractic the most common modality among patients receiving CCM services in an IHDS. More than one-third of patients self-referred to the CCM.9

Global Spine Care

  • This 2018 paper described the Global Spine Care Initiative: (1) principles to transform the delivery of spine care; (2) an evidence-based model that could be applied globally; and (3) implementation suggestions. Slides about the project can be retrieved under Electronic Supplementary Material.10
  • This report described the Global Spine Care Initiative’s development of an evidence-based care pathway that can be implemented globally. Slides about the project can be retrieved under Electronic Supplementary Material.11

Integrative Care for MSK Pain Management

  • This white paper details the evidence base for nonpharmacologic therapies effective for various types of pain.12
  • This brief critical review addresses integrative therapies for chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture.13


  1. Taylor SL, Hoggatt KJ, Kligler B. Complementary and Integrated Health Approaches: What Do Veterans Use and Want. J Gen Intern Med. 2019;34(7):1192-9.
  2. Taylor SL, Herman PM, Marshall NJ, et al. Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med. 2019;25(1):32-39.
  3. Lisi AJ, Salsbury SA, Hawk C, et al. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process. J Manipulative Physiol Ther. 2018;41(2):137-148. FREE FULL TEXT
  4. Donaldson MT, Polusny MA, MacLehose RF, et al. Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: a cross-sectional latent class analysis. BMC Complement Altern Med. 2018;18(1):246. FREE FULL TEXT
  5. Madsen C, Vaughan M, Koehlmoos TP. Use of Integrative Medicine in the United States Military Health System. Evid Based Complement Alternat Med. 2017;2017:9529257. FREE FULL TEXT
  6. Vining RD, Salsbury SA, Cooley WC, Gosselin D, Corber L, Goertz CM. Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study. J Multidiscip Healthc. 2018;11:223-231. FREE FULL TEXT
  7. Salsbury SA, Vining RD, Gosselin D, Goertz CM. Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team. Chiropr Man Therap. 2018;26:29. FREE FULL TEXT
  8. Salsbury SA, Goertz CM, Twist EJ, Lisi AJ. Integration of doctors of dhiropractic into private sector health care facilities in the United States: a descriptive survey. J Manipulative Physiol Ther. 2018;41(2):149-155. FREE FULL TEXT
  9. McCubbin T, Kempe KL, Beck A. Complementary and Alternative Medicine in an Integrated Health Care Delivery System: Users of Chiropractic, Acupuncture, and Massage Services. Perm J. 2017;21:16-172. FREE FULL TEXT
  10. Johnson CD, Haldeman S, Chou R, et al. The Global Spine Care Initiative: model of care and implementation. Eur Spine J. 2018;27(Suppl 6):925-945. FREE FULL TEXT
  11. Haldeman S, Johnson CD, Chou R, et al. The Global Spine Care Initiative: care pathway for people with spine-related concerns. Eur Spine J. 2018;27(Suppl 6):901-914. FREE FULL TEXT
  12. Tick H, Nielsen A, Pelletier KR, et al. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY). 2018;14(3):177-211. FREE FULL TEXT
  13. Lin YC, Wan L, Jamison RN. Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence. Anesth Analg. 2017;125(6):2081-2093.