Chiropractic Research

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

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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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Chiropractic Research Review 2015

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SOURCE:   Practice Analysis of Chiropractic 2015 (Chapter 2)

National Board of Chiropractic Examiners (NBCE)

Introduction

Healthcare services are provided by a practitioner in response to each patient’s expressed health concerns. Critical in this process are: the knowledge and experience of the practitioner, the preferences and values of the patient, and the empirical evidence concerning the appropriate care for the patient’s health condition. [1] This chapter focuses on the current state of scientific evidence regarding chiropractic care. The use of empirical evidence to guide practice is frequently called “evidence-based practice,” or “evidence-informed care.” Evidence-based practice was defined by one of the leading pioneers of the evidence-based movement, David Sackett, as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”. [2]

Because the types of chiropractic research investigations have expanded, this chapter addresses not only clinical and basic science research, but also cost analysis, patient safety, and patient satisfaction. To effectively organize this research evidence, this chapter is primarily focused on findings from systematic reviews and meta-analyses, which combine results from many investigations to provide summaries of evidence in a specific area of healthcare.

Through the application of evidence-based practice principles, chiropractors rely, in part, upon research when making decisions about the care of their individual patients. Likewise, policymakers require evidence on which they can base decisions regarding policies to facilitate improved health outcomes. Additionally, patients depend on their doctors to have knowledge of the best available evidence within their discipline. Therefore, it is important to understand the depth and breadth of the chiropractic evidence base, while also noting the limitations and challenges of the state of evidence. Thus, this chapter is designed to provide evidence which may enhance decision-making by doctors of chiropractic and other health professionals, patients, educators, policymakers, and payors.

Evidence that informs chiropractic practice ranges from systematic reviews/meta-analyses and randomized clinical trials to observational and case-control studies, as well as mechanical force investigations and animal studies. This chapter provides an overview of the most recent and highest quality research evidence, but is not an exhaustive listing of all studies. Additional information and discussions of other research efforts are available in Chapter 2 of the Practice Analysis of Chiropractic 2010, as well as the Job Analysis of Chiropractic 2005, 2000, and 1993. [3-6]

Clinical Effectiveness

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Chiropractic Research Section

Back Pain

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Evaluating the Relationship Among Cavitation, Zygapophyseal Joint Gapping, and Spinal Manipulation: An Exploratory Case Series

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SOURCE:   J Manipulative Physiol Ther. 2011 (Jan);   34 (1):   2–14

Gregory D. Cramer, DC, PhD, Kim Ross, DC, PhD, Judith Pocius, MS, Joe A. Cantu, DC, Evelyn Laptook, DC, Michael Fergus, DC, Doug Gregerson, DC, Scott Selby, DC, P.K. Raju, PhD

National University of Health Sciences,
Lombard, IL 60510, USA.
gcramer@nuhs.edu

OBJECTIVE:   This project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophyseal (Z) joint gapping following spinal manipulative therapy (SMT).

METHODS:   Five healthy volunteers (average age, 25.4 years) were screened and examined against inclusion and exclusion criteria. High-signal magnetic resonance imaging (MRI) markers were fixed to T12, L3, and S1 spinous processes. Scout images were taken to verify the location of the markers. Axial images of the L4/L5 and L5/S1 levels were obtained in the neutral supine position. Following the first MRI, accelerometers were placed over the same spinous processes; and recordings were made from them during side-posture positioning and SMT. The accelerometers were removed, and each subject was scanned in side-posture. The greatest central anterior to posterior Z joint spaces (gap) were measured from the first and second MRI scans. Values obtained from the first scan were subtracted from those of the second, with a positive result indicating an increase in gapping following SMT (positive gapping difference). Gapping difference was compared between the up-side (SMT) joints vs the down-side (non-SMT) joints and between up-side cavitation vs up-side noncavitation joints.

RESULTS:   Greater gapping was found in Z joints that received SMT (0.5 ± 0.6 mm) vs non-SMT joints (-0.2 ± 0.6 mm), and vertebral segments that cavitated gapped more than those that did not cavitate (0.8 ± 0.7 vs 0.4 ± 0.5 mm).

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What is the Chiropractic Subluxation Page

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Chiropractors Included in New Danish Muscle and Joint Health Research Team

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SOURCE:   WFC Quarterly World Report 2015 (Sep) (see page 5) ~ FULL TEXT

A team of leading researchers, including chiropractors, have founded a new research institute that aims to become a top centre for musculoskeletal health.

The researchers, from the University of Southern Denmark, have founded the
Center for Muscle and Joint Health.

With a stated aim of reducing the burden of musculoskeletal health, investigators will look at pain and functional loss in joints.

Research has previously shown that a Dane loses an average of seven years of good quality of life due to pain and functional problems related to the musculoskeletal system. Muscle and joint disorders now constitute the major cause of functional impairment of populations in Europe – larger than other common disorders like depression, dementia and heart disease.

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