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Table 2.

Interprofessional communications during case co-management

WeekCommunication TypePatient GoalsInterprofessional Communication Summary
1Treatment summary/DC
  • Pain reduction for LBP
  • Improved psychological management of chronic pain
  • Improved ability to perform ADLs (gardening, walking)
  • Low back pain diagnosis with description and rationale for recommended treatment
  • Lumbar distraction
  • Gentle high velocity manipulation at the left sacroiliac joint to improve joint function
  • Home exercise recommendations included trunk motions and brisk walking using a short stride with mild effort to tolerance
  • Tobacco cessation advised
3Treatment summary/DO
  • Short-term pain management
  • Tobacco use cessation due to the costs of smoking and expressed embarrassment from habit
  • Low back pain and tobacco use diagnosis with treatment recommendations
  • Acetaminophen recommended for short term pain relief
  • Continue chiropractic care as scheduled
  • Weight reduction through diet (increased physical activity not recommended due to pain with movement)
  • Tobacco cessation with nicotine patch
  • Review of previous medications and side effects for smoking reduction
4Phone call summary/DO
Phone call summary/DC
  • Tobacco use and excess weight as factors that worsen inflammation in patients with chronic low back pain
  • Pain reduction techniques, such as relaxation response
5Health records/DC
  • Tobacco use reduction or cessation
  • Personal Quit Plan with behavioral measures along with nicotine patch to support tobacco reduction
6Treatment summary/DC
  • Tobacco use reduction or cessation
  • Cessation length compared to previous history (current effort lasted 6.5 days; Previous cessation lasted 6 days during an inpatient hospitalization without access to cigarettes.)
  • Challenges related to life stresses (family stress, lack of sleep, and increased LBP combined to decrease ability to resist smoking)
  • Home exercise recommendations included thoracolumbar lateral flexion isometric exercises
12Phone call summary/DO
Phone call summary/DC
  • Summary of gains with treatment
  • Decreased pain level
  • Improved ability to perform ADLs
  • Reduced pain medication

Future recommendations
  • Acetaminophen as needed for pain
  • Walking regularly for exercise
  • Avoiding twisting and lifting while performing ADLs such as gardening
  • Continued smoking cessation efforts.
14Treatment summary/DC
  • Better understanding condition and self-management tools.
  • Diagnosis
  • Summary of care
  • Treatmentgoals
  • Outcomes relating to decreased pain with ADLs
  • Result of tobacco cessation effort, and
  • Continued recommendations for tobacco reduction
  • Performing exercises more regularly
  • Chiropractic and/or medical care on an as needed basis