V A Dantas Melo, J R Santos Silva, R La Corte
Use of mosquito repellents to protect against Zika virus infection among pregnant women in Brazil
Public health
randomized clinical trials rcts gold standard assessing treatment effectiveness however criticized generalizability issues well trial participants represent receive treatments clinical practice assessed representativeness participants eight rcts chronic spine pain us used individual participant data metaanalysis costeffectiveness spinal manipulation spine pain clinical trials spinal manipulation performed chiropractors conducted retrospective secondary analysis rct data compare trial participants sociodemographic characteristics clinical features health outcomes representative sample us adults chronic spine pain b us adults chronic spine pain receiving chiropractic care using secondary data national health interview survey nhis medical expenditure panel survey meps assessed differences trial us spine populations using independent ttests means ztests proportions accounting complex multistage survey design nhis meps found clinical trials underrepresentation individuals health disparity populations lower percentages racial ethnic minority groups blackafrican american 7 lower hispanic 8 lower less educated high school degree 19 lower high school degree 11 lower unemployed adults 25 lower worse health outcomes physical health scores 25 lower mental health scores 53 lower using sf1236 relative us population spine pain odds chiropractic use us lower individuals health disparity populations trials also underrepresented populations relative us adults chronic spine pain visit chiropractor health disparity populations well represented spine pain clinical trials embracing key communitybased approaches shown promise increasing participation underserved communities needed