• Bussières A
• Passmore S
• Kopansky-Giles D
• Tavares P
• Ward J
• Ladwig J
• Glazebrook C
• Mior S
• Atkinson-Graham M
• Moss J
• Robak N
• Broeckelmann E
• Monias DA
• McKay DZ
• Hamilton H
• Scott M
• Smolinski R
• Hurwitz EL
• Woolf AD
• Johnson M
• Fowler-Woods MJ
• Haldeman S

• Affiliation / Canadian Memorial Chiropractic College (CMCC). Division of Graduate Education and Research
• Affiliation / McGill University. Faculty of Medicine. School of Physical and Occupational Therapy
• Affiliation / Université du Québec à Trois-Rivières (UQTR). Département de chiropratique
• Affiliation / University of Manitoba. Department of Surgery
• Affiliation / University of Manitoba. Faculty of Kinesiology & Recreation Management
• Affiliation / University of Toronto. Department of Family and Community Medicine
• Affiliation / World Spine Care
• Chiropractic
• Clinical Protocols
• Community-Based Participatory Research
• Implementation Science
• Indigenous Peoples
• Medically Underserved Area
• Open Access Document
• Spine
• Value-Based Health Care
• Vulnerable Populations

Background: Since the 1990s, spine disorders have remained the leading cause of global disability, disproportionately affecting economically marginalized individuals, rural populations, women, and older people. Back pain related disability is projected to increase the most in remote regions where lifestyle and work are increasingly sedentary, yet resources and access to comprehensive healthcare is generally limited. To help tackle this worldwide health problem, World Spine Care Canada, and the Global Spine Care Initiative (GSCI) launched a four-phase project aiming to address the profound gap between evidence-based spine care and routine care delivered to people with spine symptoms or concerns in communities that are medically underserved. Phase 1 conclusions and recommendations led to the development of a model of care that included a triaging system and spine care pathways that could be implemented and scaled in underserved communities around the world.

Methods: The current research protocol describes a site-specific customization and pre-implementation study (Phase 2), as well as a feasibility study (Phase 3) to be conducted in Cross Lake, an Indigenous community in northern Manitoba, Canada. Design: Observational pre-post design using a participatory mixed-methods approach. Relationship building with the community established through regular site visits will enable pre- and post-implementation data collection about the model of spine care and provisionally selected implementation strategies using a community health survey, chart reviews, qualitative interviews, and adoption surveys with key partners at the meso (community leaders) and micro (clinicians, patients, community residents) levels. Recruitment started in March 2023 and will end in March 2026. Surveys will be analyzed descriptively and interviews thematically. Findings will inform co-tailoring of implementation support strategies with project partners prior to evaluating the feasibility of the new spine care program.

Discussion: Knowledge generated from this study will provide essential guidance for scaling up, sustainability and impact (Phase 4) in other northern Canada regions and sites around the globe. It is hoped that implementing the GSCI model of care in Cross Lake will help to reduce the burden of spine problems and related healthcare costs for the local community, and serve as a scalable model for programs in other settings.

Author keywords: Participatory mixed-methods - Spine care - Value-based healthcare - Implementation science - Medically underserved area - Vulnerable population - Protocol - Chiropractic - Indigenous

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