Chiropractic Research & Practice: State of the Art
By Daniel Redwood, D.C., professor, Cleveland Chiropractic College
Since chiropractic’s breakthrough decade in the 1970s — when the U.S. federal government included chiropractic services in Medicare and federal workers’ compensation coverage, approved the Council on Chiropractic Education (CCE) as the accrediting body for chiropractic colleges, and sponsored a National Institutes of Health (NIH) conference on the research status of spinal manipulation—the profession has grown and matured into an essential part of the nation’s healthcare system.
Autism: A Chiropractic Perspective
Clinical Chiropractic 2006 (Mar): 9 (1): 6-10 ~ FULL TEXT
Aguilar et al. (25) carried out a series of chiropractic adjustments on 26 autistic children over a 9-month period. Twelve were found to have a left atlas laterality and 14 had a right atlas laterality. Outcomes from the study were varied but included normalization of deep tendon reflexes and dermatomal subjective sensation, increased cervical range of motion and reduction of other health problems. Many of the children were taken off Ritalin, bladder and bowel control improved, some children started to speak and eye contact and attention span also improved in some children. Hyperactivity and aggressive behaviour were reduced in other children and five children were able to attend mainstream classes at school for the first time. Behavioural data, recorded by the teachers and parents, showed significant improvements in most cases.
The International Conference on Chiropractic Research:
Promoting Excellence in Chiropractic Research Worldwide
J Manipulative Physiol Ther 2006 (Jan); 29 (1): 1–3 ~ FULL TEXT
The January 2006 issue of Journal of Manipulative and Physiological Therapeutics publishes the prize-winning papers from the International Conference on Chiropractic Research (ICCR) held at the Sydney Convention Centre, Australia, from June 16 to 18, 2005. This conference was the inaugural ICCR, and it combined two events that were previously held separately. The first is the WFC's original research symposium and competition, which has been held every 2 years since 1991 as part of WFC's Biennial Congress. In recent times, the competition has had four prizes totaling US$15,000 generously sponsored by the National Board of Chiropractic Examiners. Prize-winning papers have traditionally been published in Journal of Manipulative and Physiological Therapeutics, in January or February of the year following the WFC Congress. Past prize winners are listed in Table 1.
How to Research, Write, and Edit a Manuscript For Peer-revied Journals:
The Journal Article Cookbook
J Manipulative Physiol Ther 2004 (Sep); 27 (7): 481–492 ~ FULL TEXT
However, the purpose of this article is not to sing our own praises or to pat ourselves on the back. Rather, we have a much more humble goal in mind. We figure that, if we can get our works published, so can others. The problem is that many people in the chiropractic profession who are endowed with considerable research skills or a wealth of clinical experience or who just have something interesting to say, may not know how to go about accomplishing an intimidating task, namely, the researching, writing, and editing of a manuscript so that it survives the peer-review process and is judged suitable for publication in a reputable journal. Because we believe the future triumphs of the profession will depend on the ongoing accrual and dissemination of scientific knowledge originating from within the chiropractic community, it is our intent to provide the reader with a step-by-step strategy to overcome many of the hurdles facing a novice author.
Is Chiropractic Evidence Based? A Pilot Study
J Manipulative Physiol Ther 2003 (Jan); 26 (1): 46 ~ FULL TEXT
When patients were used as the denominator, the majority of cases in a chiropractic practice were cared for with interventions based on evidence from good-quality, randomized clinical trials. When compared to the many other studies of similar design that have evaluated the extent to which different medical specialties are evidence based, chiropractic practice was found to have the highest proportion of care (68.3%) supported by good-quality experimental evidence.
Fables or Foibles: Inherent Problems with RCTs
J Manipulative Physiol Ther 2003 (Sept); 26 (7): 460 ~ FULL TEXT
The 7 case studies reviewed in this report combined with an emerging concept in the medical literature both suggest that reviews of clinical research should accommodate our increased recognition of the values of cohort studies and case series. The alternative would have been to assume categorically that observational studies rather than RCTs provide inferior guidance to clinical decision-making. From this discussion, it is apparent that a well-crafted cohort study or case series may be of greater informative value than a flawed or corrupted RCT. To assume that the entire range of clinical treatment for any modality has been successfully captured by the precision of analytical methods in the scientific literature, indicates Horwitz, would be tantamount to claiming that a medical librarian who has access to systematic reviews, meta-analyses, Medline, and practice guidelines provides the same quality of health care as an experienced physician.
Effect of Interpretive Bias on Research Evidence
British Medical Journal 2003 (Jun 28); 326 (7404): 1453–1455 ~ FULL TEXT
Doctors are being encouraged to improve their critical appraisal skills to make better use of medical research. But when using these skills, it is important to remember that interpretation of data is inevitably subjective and can itself result in bias. Facts do not accumulate on the blank slates of researchers' minds and data simply do not speak for themselves. (1) Good science inevitably embodies a tension between the empiricism of concrete data and the rationalism of deeply held convictions. Unbiased interpretation of data is as important as performing rigorous experiments. This evaluative process is never totally objective or completely independent of scientists' convictions or theoretical apparatus. This article elaborates on an insight of Vandenbroucke, who noted that "facts and theories remain inextricably linked... At the cutting edge of scientific progress, where new ideas develop, we will never escape subjectivity." (2) Interpretation can produce sound judgments or systematic error. Only hindsight will enable us to tell which has occurred. Nevertheless, awareness of the systematic errors that can occur in evaluative processes may facilitate the self regulating forces of science and help produce reliable knowledge sooner rather than later.
Cultural Authority, Best Practices, and Chiropractic Theory:
A Dilemma for Chiropractic?
William Meeker, DC, MPH, FICC
The recent article "In the Quest for Cultural Authority" by Keating et al.1 indicates the re-emergence of a valuable dialog concerning the appropriate role of scientific evidence in making decisions about chiropractic identity and practice. The positions are familiar. On the one hand, we have a call to recognize the tenuous scientific basis of subluxation and related chiropractic theories. On the other, we have a real need to politically unify the profession around a unique, powerful, and easily identifiable niche in the fast evolving world of health care. I see the need for both, but the way by which we arrive at an appropriate solution is hard to see. It does seem risky to stake our profession's future on a yet-to-be thoroughly tested set of neurological hypotheses, but it also seems risky to continue to confuse the public and professional communities about chiropractic's role and value.
Chiropractic Science Is Evolving!
William Meeker, DC, MPH, FICC
The Palmer Center for Chiropractic Research has received NIH funding for a "Center for the Study of Mechanisms and Effects of Chiropractic Manipulation." The center includes four interrelated projects in which, in part, we will attempt to elucidate both physiological and clinical differences between HVLA and LVVA procedures. We are going to apply this body of knowledge in two animal models and one clinical scenario, in order to get a better handle on whether, and if so, how, the HVLA and LVVA biomechanical profiles yield different clinical and physiological responses.
Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner
for Patients with Neck Pain. A Randomized, Controlled Trial
Ann Intern Med 2002 (May 21); 136 (10): 713–722
Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. In this study, manual therapy was a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
Randomised Clinical Trial of Manipulative Therapy and Physiotherapy
for Persistent Back and Neck Complaints: Results of One Year Follow Up
British Medical Journal 1992 (Mar 7); 304 (6827): 601–605
Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.
The Research Challenge:
An Update on the Progress of the CCCR
William Meeker,D.C., MPH, FICC
As the Consortial Center for Chiropractic Research (CCCR) closes in on its last year of support from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), it is good to consider the impact that federal funding has had on the overall chiropractic research effort. Originally, there were 12 specific aims that the CCCR was required to address, most of them falling into the areas of research capacity building, training and assisting chiropractic investigators, and reviewing, prioritizing and funding small pilot studies.
The Next Big Research Thing
Robert Mootz, D.C.
Over the past few months, I have enjoyed the discussion on these pages about published articles, research needs, challenges, etc. In particular, I have been invigorated by the academic crossfire between Drs. Robert Cooperstein, et al., and Arlan Fuhr, prompted by Dr. Meridel Gatterman and her team's undertaking of rating chiropractic technique procedures for common low back conditions.
This is the 9th Chapter from the the Agency for Health Care Policy and Research
(AHCPR Publication No. 98-N002 December 1997) monologue, titled “Chiropractic in the United States: Training, Practice, and Research”
Moving Chiropractic Forward:
An Interview with Bill Meeker, D.C., M.P.H.
This interview with Dan Redwood, D.C. starts: “Since being named in 1998 to head the Consortial Center for Chiropractic Research (CCCR), Bill Meeker has been at the center of a burgeoning chiropractic research effort. Supported by the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM), CCCR is a joint endeavor that currently includes six chiropractic colleges and three state-supported universities. Its essential mission is twofold: to support high quality research projects and to create a sustainable chiropractic research infrastructure.”
Issues in Planning a Placebo-controlled Trial of Manual Methods:
Results of a Pilot Study
J Altern Complement Med 2002 (Feb); 8 (1): 21–32
The technical and personnel resources required to achieve adequate standardization of procedures at multiple sites may make a placebo-controlled trial unfeasible, given our current lack of knowledge about the active agent in manual chiropractic procedures.
Chiropractic: A Profession at the Crossroads
of Mainstream and Alternative Medicine
Ann Intern Med 2002 (Feb 5); 136 (3): 216–227
Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine.
The Efficacy of Spinal Manipulation, Amitriptyline and the Combination
of Both Therapies for the Prophylaxis of Migraine Headache
J Manipulative Physiol Ther 1998 (Oct); 21 (8): 511–519
There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches. There are more articles like this in the Headache Section
Manual Medicine Diversity:
Research Pitfalls and the Emerging Medical Paradigm
J Am Osteopath Assoc 2001 (Aug); 101 (8): 441-444 ~ FULL TEXT
Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists.
Japanese Foundation for Spinal Research Established
At a January 12, 2002 meeting in Tokyo, the Japanese Foundation for Spinal Research (JSFR) was founded. It is a non-profit organization designed to support and disseminate the results of research pertaining to the human spine and related tissues. The formation of the JSFR was made possible by generous financial support from the Canadian Memorial Chiropractic College, Cleveland Chiropractic College, and Southern California University of Health Sciences.
Clinical Study on Manipulative Treatment of Derangement
of the Atlantoaxial Joint
J Tradit Chin Med 1999 (Dec); 19 (4): 273-278
The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.
Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture,
A Nonsteroidal Anti-inflammatory Drug, and Spinal Manipulation
J Manipulative Physiol Ther 1999 (July); 22 (6): 376–381
The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.
Malik Slosberg, D.C. Talks about Chiropractic Research With MD's
On Saturday, February 16, 2002, at the 54th Annual Scientific Assembly of the California Academy of Family Physicians in San Francisco, I had the opportunity to offer a presentation on "Chiropractic in Family Practice." Of the 27 presenters, I was the only chiropractor to lecture at the conference of more than 400 physicians.
Northwestern Chiropractic College receives $3.4 Million
in Federal Research Grants in 2001
The National Institute of Health's (NIH) recent award of a $1.5-million research grant to Northwestern Health Sciences University brought the school's total federal funding for health care research projects to more than $3.4 million in 2001. The $1.5 million NIH grant is for a five-year study on acute neck pain, the largest research study in the history of Northwestern. The study will be conducted by Northwestern's Wolfe-Harris Center for Clinical Studies.
The Research Agenda Conference (RAC IV): Chiropractic Theory in Research:
Subluxation Theory Finally Gets the Attention It Deserves
Robert Mootz, D.C.
Theories are designed to explain observable phenomena. In actuality, the "subluxation model" that postulates a relationship between body structure, physiological function and health is an inherently viable one. The precise biomechanical, neurophysiological and/or psychosocial mechanisms that may or may not come into play remain to be elucidated through research. As more becomes known, chiropractic models should rightly be refined to better explain clinical observations. Well-developed theories help pose research questions and study designs that do a better job at finding out information that can improve our practices and benefit the patients we are here to serve.
Canada's First Chiropractic Research Chair is Announced!
After a stringent peer review, Canada's first chiropractic research chair was awarded to Greg Kawchuk, DC, PhD. at the University of Calgary (UC). As the first research position in Canada specifically devoted to chiropractic research supported directly by the federal government, it was presented according to guidelines established by the Canadian Institutes of Health Research (CIHR), the Canadian Chiropractic Association (CCA), the Canadian Chiropractic Research Foundation (CCRF), and the Foundation for Chiropractic Education and Research (FCER).
Chiropractic Research Retrospective
Thirty years ago, when I finished chiropractic college, chiropractic research was an oxymoron. In fact, research specific to spinal manipulative therapy, or more specifically chiropractic manipulative therapy/adjustment as performed by doctors of chiropractic, just didn’t exist. Since that time, this has changed dramatically—especially over the last 20 years. In fact, it was only 20 years ago this year that the first peer-reviewed, and subsequently indexed, scientific journal was developed in the chiropractic profession, now known as the Journal of Manipulative and Physiological Therapeutics (JMPT). Even 13 years ago, there was only this one scientific journal in the chiropractic profession. Today, there are more than 10 peer-reviewed scientific chiropractic journals in North America alone.
Palmer Receives $1.3 Million Construction Grant from Nat'l Center
for Research Resources
Palmer Chiropractic University Foundation (PCUF) has been awarded a facilities construction grant for $1.3 million from the National Center for Research Resources, a division of the U.S. National Institutes of Health (NIH).
Drs. Meeker and Rosner Testify before White House Commission
on CAM Policy
On October 5, 2000, William Meeker,DC,MPH, director of the Palmer Center for Chiropractic Research, and Anthony Rosner,PhD, director of research for the Foundation for Chiropractic Education and Research, testified before the newly formed White House Commission on Complementary and Alternative Medicine Policy in Washington, D.C.
Rehab RAC 'n' Roll
Craig Liebenson, DC
Mention a research meeting to practicing chiropractors and you will get a typical response: "Boring!" Mention Chicago in the summertime and you think "hot and muggy." So, it was surprising that the recent Research Agenda Conference V (RAC V) was anything but boring!
Vertebral Subluxation-Centered Straight Chiropractic Research
Chiropractic Research Journal 1999; 6 (1): 12-13
Straight chiropractic has been considered by some an anti-scientific approach to health care, because of statements made both by its proponents and its detractors(1). Indeed, certain tenets of straight chiropractic, particularly its reliance on an innate, immaterial organizing principle, may not be testable with the scientific method, but must be taken on faith or by assumption. Still, the claim that detection and removal of vertebral subluxation can be of benefit to humans, regardless of the mechanism of that effect, should be testable in an objective manner.
Palmer's Research Director Represents Chiropractic
at Alternative Care Meetings
William Meeker,DC,MPH, director of research, Palmer Center for Chiropractic Research, was invited to speak at two meetings in Boston, Mass. (March 12-15, 2000), focusing on complementary and alternative medicine (CAM). The meetings were sponsored by the Harvard Medical School teaching hospital, Beth Israel Deaconess Medical Center and the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health.
Scratching Where It Itches:
Core Issues in Chiropractic Research
Anthony Rosner, PhD
With the recent burst of media coverage of both alternative
medicine and chiropractic intervention, I have felt compelled to redouble our ongoing efforts to identify some predominating elements and trends in health services research in general, and chiropractic research in particular. I was fortunate enough to find some help in doing this at the Third International Forum for Primary Care Research .
Comments on the History of Chiropractic Research
Chiropractic in the United States: Training, Practice, and Research
AHCPR Publication No. 98-N002 December 1997
Check out the Palmer Research Publications!
Here's access to their Peer-Reviewed Publications
CMCC Awarded $1 Million Research Grant for Headache Study
American Public Health Association (APHA) Announces Call for
The response to the Dysmenorrhea Study Published April 1999
in the Pain Journal
Anthony Rosner, PhD, director of research
Foundation for Chiropractic Education and Research
Patricia Brennan's dysmenorrhea study, a full-scale clinical trial begun in 1992, has resulted in a paper accepted for publication in April 1999 by the journal Pain.  It was preceded by a pilot study addressed to the same issue which was published in the Journal of Manipulative and Physiological Therapeutics in 1992 . Unfortunately, the recent publication in Pain suffers from a number of design flaws, omissions of data, and unexplained contradictions with the earlier pilot study--all of which significantly compromise its validity and leave more questions unanswered than resolved.
What Are the Effects of Zero Gravity on the Spine?
Chiropractic Study Seeks the Answers with NASA's Help
Chiropractic Research Journal Editors' Council