Doctors of chiropractic working with or within integrated health care delivery systems: a scoping review protocol
Authors: Roseen Eric J. , Kasali Aisha B. , Corcoran Kelsey , Masselli Kelsey , Laird Lance , Saper Robert , Alford Daniel P. , Cohen Ezra , Lisi Anthony , Atlas Steven J. , Bean Jonathan F. , Evans Roni , Bussières André 
Published: August 2020

ABSTRACTIntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide nonpharmacologic treatment aligned with international clinical practice guidelines. Although DCs practice in at least 90 countries, chiropractic care is often not available within integrated health care delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improved collaboration between medical providers and community-based DCs, or embedding DCs in medical settings such as hospitals or community health centers, will improve access to evidence-based care for musculoskeletal conditions.Methods and analysesThis scoping review will map studies of DCs working with or within integrated health care delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase, and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (e.g., shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention; implementation strategies; and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based survey.Ethics and disseminationEthics approval will not be obtained for this review of published and publicly accessible data. Our results will be disseminated through conference presentations and a peer-reviewed publication. Our findings will inform implementation strategies that support the adoption of chiropractic care within integrated health care delivery systems.Strengths and limitations of this studyThis scoping review will be among the first to comprehensively map literature of doctors of chiropractic (DCs) working with or within military, veteran or civil integrated health care delivery systems.The literature search strategy is comprehensive and potentially generalizable to a global DC workforce, and relevant to other nonpharmacologic therapy providers who typically work in the community, e.g., acupuncturists, psychologists.A multidisciplinary team with diverse clinical and research expertise will inform our scoping review across all stages of the work.We have organized our search strategy and extraction form/guide around standardized terminology from the field of implementation science. It may be challenging to identify relevant studies, or extract all useful information, if original research does not use this terminology.Non-English articles describing the implementation of chiropractic care in a medical setting may be missed.