of chiropractic clinical research palmer center for chiropractic research
DESCRIPTION
Basic: investigates physiological mechanism(s) by which chiropractic works: WHY and HOW Clinical: investigates actual effects on patients: IF, WHEN and WHOM èBoth are necessary but each requires specialized skills to conduct.TRANSCRIPT
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,