Yearly Archives: 2016

Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
Part C:  Mixed Methods:   “Why Can’t Science And Chiropractic Just Be Friends?”

The Chiro.Org Blog

SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

Many commentators have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, observing the way Evidence-based Practice [EBP] is sometimes implemented is controversial, not only within the chiropractic profession, but in all other healthcare disciplines, including medicine itself.   A phased approach to the development and evaluation of complex interventions can help researchers define the research process and complex interventions may require use of both qualitative and quantitative methods.   The chiropractic profession has little to fear from evidence-based practice; in fact it should be used productively to improve patient care, clinical outcomes and the standing of the profession in the eyes of the public, other health professions and legislators.

Keywords Evidence-Based Practice; Mixed Methods; Research Design

INTRODUCTION

Many scientists have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, including chiropractic. Over the last decade some authors have suggested refinements of the model, for instance;   in the place of an evidence hierarchy, Jonas [1] suggested the construction of an “evidence house” with “rooms” for different types of information and purposes and later presented a refined circular model. [1]

Jonas [1] observed:

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Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”  
Part B.   Qualitative Research;   Quality vs. Quantity

The Chiro.Org Blog

SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–14

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

The plethora of quantitative evidence in chiropractic science stands in contrast to the relative dearth of qualitative studies. This phenomenon exists in spite of the intuitive impression that chiropractic is indeed suitable for investigation with a variety of qualitative methodologies. There is a long tradition of qualitative investigation in the social sciences, which focuses on gathering rich experiential data, recognising both that health research deals with ‘real’ people, and that people are not predictable or pre-determined. Qualitative chiropractic research can examine various aspects of a “package” of care and the participants “care journey” and the interplay between verbal and nonverbal, including tactile interactions, which may be diagnostic or therapeutic. Research in chiropractic ideally integrates experience, neurobiology and nonlinear dynamic thinking. Many chiropractic scientists are used to only working with linear models, consequently they may be reluctant to adopt the nonlinear framework of complexity theory and recognise that the analysis of lived experience including subjective phenomena can be an integral part of studies in the chiropractic space.

Keywords Evidence-Based Practice; Qualitative Research; Research Design

INTRODUCTION

This paper examines the application of qualitative methodology in the chiropractic sector. Philosophers of science have long observed that the positivist paradigm that underpins quantitative research can itself easily become a dogma, they recognise that science can never ‘prove itself’ and many would no doubt agree with Dupre that it may indeed become a form of ‘scientific imperialism’. [1-3] There is thus an increasing recognition that devotion to a purely quantitative methodology in the health sciences is at best, ‘unbalanced’. [1] This paper will lead the reader through a preliminary description of qualitative research methodologies while providing an overview of the major paradigms on which qualitative research is based, along with selected chiropractic examples.

Importance of Qualitative Research to Chiropractic Health Research

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Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
Part A. Quantitative Research: Size Does Matter

The Chiro.Org Blog

SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

Many chiropractors remain skeptical of evidence-based practice (EBP) and some may view it as an attack on the profession which they feel must be resisted. A counter-argument is centred on the primacy afforded quantitative methodology as epitomised by the randomised controlled trial (RCT). This defensive posture may be mitigated by recognising the role complex research has played in the legitimisation of the profession. The pre-eminence of the randomised controlled trial (RCT), considered by many as the gold-standard of evidence, has led some authors to go so far as to functionally disregard all evidence that is not an RCT. However, it is readily apparent the RCT is not always the most appropriate study design to gather evidence, especially in the CAM health sector. This paper discusses the role of sophisticated design in quantitative chiropractic research, presenting examples sequentially through the traditional quantitative hierarchy and concludes that optimal methodology depends on the research question. Research design must allow for the various dimensions of the (chiropractic) clinical encounter, and may be sophisticated at all levels, but must above all, be contextual. The ‘best available’ or most relevant evidence depends on what one needs for a specific purpose. A critical caution is the proviso that care must be exercised not to draw inappropriate conclusions such as causation from descriptive studies.

INDEX TERMS: Chiropractic; Evidence-Based Practice; Quantitative Evaluation; Research Design

INTRODUCTION

Proponents and detractors of evidence-based practice (EBP) in chiropractic, in common with the rest of healthcare, generally adopt antithetical positions characterised more by dogmatic convictions than by genuine debate. Some consider RCT evidence as the gold standard of sophisticated evidence, while others are highly critical. [1] The principal proposition of this paper will be that sophisticated research designs have an important role in generating new knowledge at all ‘levels’ of the hierarchy and should not be avoided because of the challenge presented by complexity. It is my view that a sequential analysis of the various study designs in clinical and health system research demonstrates that different designs have each added a unique dimension to the corpus of knowledge concerning chiropractic, manual therapy, spinal pain complementary medicine and human well-being. A study may reside ‘lower’ on the evidentiary hierarchy, but this certainly does not preclude it from being complex, sophisticated or valuable.

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