ofChiropractic Clinical

Research

Palmer Center for Chiropractic Research

. . .is to improve practice, not prove it.

Basic: investigates physiological mechanism(s) by which chiropractic works: WHY and HOW

Clinical: investigates actual effects on patients: IF, WHEN and WHOM

Both are necessary but each requires specialized skills to conduct.

Where are we now?

41 RCTs of “smt” (some DC, some DO) 28: positive 13: equivocal

51+ systematic reviews—34+ positive Moderate evidence for acute and

chronic LBP for short-term outcomes Insufficient evidence for LBP with

sciatica

11 RCTs 4 positive 7 equivocal

2 meta-analyses both positive

“weak cumulative evidence”

9 RCTs (3 for migraine) 7 positive (2 for migraine) 2 equivocal (1 for migraine)

Evidence is mixed but promising for certain types of headache

1 equivocal

Few case reports (<35 Medline) No observational studies Few experimental studies 9 RCTs for 6 conditions One systematic review: evidence not

sufficient for or against any of these conditions at this time

ZZEE

RRO!O!

Why don’t we have more and better

evidence?

Current

Refined RCTs

Case ReportsOther

Observational

Pre-exp./preliminary

Part 3: How do we build the

evidence base?

RCTsRCTsOther

ExperimentalQuasi-Experimental

Observational Case reports/Clin. Observ.

The Hierarchy of Evidence

LESS convinci

ng

MORE convinci

ng

LAST!

FIRST!

RCTsOther

ExperimentalQuasi-

ExperimentalObservational

Case reports/Clinical

observations

Evidence in Chiropractic

LESS convinci

ng

MORE convinci

ng

FIRST/ MOST!

Later if at all…

How do we build a How do we build a stronger base?stronger base?

More and better:

anandd

To build a stronger base:What works best for whom?

Case reports on chiropractic care Observational studies

Population based Practice based

Preliminary and pilot studies to refine questions

Current

Refined RCTs

Case Reports

OtherObservational

Pre-exp./preliminary

Evidence base congruent with our

practice and philosophy

What do we need to see in case reports?

Publication in indexed peer-reviewed journals

Reports of chiropractic care Details on techniques Details on frequency and duration

Use of outcome assessments Reliable, valid, responsive Measure the outcome of interest

Building the evidence Building the evidence base in chiropractic…base in chiropractic…

Meta- AnalysesRCTs

Other ExperimentalQuasi-Experimental

ObservationalCase reports/Clinical

observations

Meta-AnalysesRCTs

Other ExperimentalQuasi-Experimental

ObservationalCase reports/

Clinical observations

Case reports on specific care protocols and outcomes

Pre-experimental studies refining questions

Refined RCTs congruent with

chiropractic philosophy

Current

Refined RCTs

Case Reports

Observational

Pre-experimental

Write a case report describing chiropractic management in detail This helps refine research questions This provides evidence for proposing

clinical experimental studies

Publication in indexed peer-reviewed journals

Reports of chiropractic management Details on techniques Details on frequency and duration

Use of outcome assessments Reliable, valid, responsive Measure the outcome of interest

if you don’t publish it...

In the world of evidence-based practice,