RESEARCH METHODSRESEARCH METHODS

Dwain Daniel D.C.

Only in CaliforniaOnly in California

Mission of Research at PCCMission of Research at PCC

• Conduct research to support and improve chiropractic practice

• Publish research work• Present research• Involve faculty, students, staff & alumni in the research

process• Communication

– Research Status Reports– Bulletin boards, etc.

• Conduct research to support and improve chiropractic practice

• Publish research work• Present research• Involve faculty, students, staff & alumni in the research

process• Communication

– Research Status Reports– Bulletin boards, etc.

Why this Class (Specific Objectives)

• Develop an understanding of the importance of research to the profession

• Provide the skills necessary to find the information you want.

• Develop critical reading skills to understand what you have found:

BOTTOM LINE- No matter where you practice…. you will be able to locate, understand and apply the scientific literature to keep

you on the cutting edge of professional practice

BOTTOM LINE- No matter where you practice…. you will be able to locate, understand and apply the scientific literature to keep

you on the cutting edge of professional practice

Putting research into perspective within the chiropractic profession*Putting research into perspective within the chiropractic profession*

• The art, science and philosophy of chiropractic

• Art: “a system of principles and methods employed in the performance of a set of activities”

• The art, science and philosophy of chiropractic

• Art: “a system of principles and methods employed in the performance of a set of activities”

**

• Philosophy: “the investigation of reality, knowledge or values based on logical reasoning rather than on scientific/empirical methods”

• Science: “the observation, identification, description, experimental investigation and theoretical explanation of phenomena”

• Philosophy: “the investigation of reality, knowledge or values based on logical reasoning rather than on scientific/empirical methods”

• Science: “the observation, identification, description, experimental investigation and theoretical explanation of phenomena”

Dogma DefinedDogma Defined

• 1. “Principle, tenet, or creed, especially of a church or political party.”

• 2. “Rigid or authoritarian belief.”The American Century Dictionary, 1995

• 1. “Principle, tenet, or creed, especially of a church or political party.”

• 2. “Rigid or authoritarian belief.”The American Century Dictionary, 1995

100 Years Ago (Getting a Perspective of Change)

100 Years Ago (Getting a Perspective of Change)

• Only 8,000 cars in the US & only 144 miles of roads

• 14% of homes had bathtubs• 8% of homes had telephones...• Max. speed limit in cities was 10MPH• Average U.S. wage was 22 cents per hr.• 95% of births took place at home• Life expectancy was 55 years

• Only 8,000 cars in the US & only 144 miles of roads

• 14% of homes had bathtubs• 8% of homes had telephones...• Max. speed limit in cities was 10MPH• Average U.S. wage was 22 cents per hr.• 95% of births took place at home• Life expectancy was 55 years

100 Years Ago

• There was no Mother’s or Father’s Day• Coca-Cola contained cocaine not caffeine• Most women washed their hair once per month with

borax or egg yokes• California was the twenty-first most populous state• 6% in the U.S. graduated from high school• The average American got 9 hours of sleep a night

Medicine 100 Years Ago

• 90% of U.S. physicians had no college ed.• Medical schools were condemned by the press

and by the government as “substandard”• Leading causes of death were: 1)Pneumonia &

Influenza, 2)TB, 3)Diarrhea, 4)Heart Disease, and 5) Stroke.

• Marijuana, heroin & morphine could be bought over the counter

Historical Changes in Research (methods)**

Historical Changes in Research (methods)**

• 1900—– Practice>>>theory>>limited science>>no clinical

research

• 1950-– Theory>>science>>practice>>clinical research

• 2000—– Science>>theory>>clinical research>>practice

– from Haldeman, DC, PhD, MD

• 1900—– Practice>>>theory>>limited science>>no clinical

research

• 1950-– Theory>>science>>practice>>clinical research

• 2000—– Science>>theory>>clinical research>>practice

– from Haldeman, DC, PhD, MD

Changes in Number of Scientists Publishing*

Changes in Number of Scientists Publishing*

• There were approximately 1,000 scientists in 1800

• This grew to nearly 100,000 in 1900

• And to more than 3,200,000 by 1972 – ...Arch Dermatol 128: 1249-1256

• There were approximately 1,000 scientists in 1800

• This grew to nearly 100,000 in 1900

• And to more than 3,200,000 by 1972 – ...Arch Dermatol 128: 1249-1256

Changes & the Challenge of Keeping Informed*

Changes & the Challenge of Keeping Informed*

• There are now approx. 18,000 biomedical journals

• By 1984 it was estimated that 7,000 scientific articles were published daily...all providing new information

• Without proper informatics & critical reading skills, this information simply can not be accessed or understood

• There are now approx. 18,000 biomedical journals

• By 1984 it was estimated that 7,000 scientific articles were published daily...all providing new information

• Without proper informatics & critical reading skills, this information simply can not be accessed or understood

The Pragmatic Reasons for this Research Class**

• help you provide the best patient care• reduced risk of malpractice (risk management)• evidence-based practice & getting paid• information for patient education (newsletters,

lectures, etc.)• help with interprofessional relations (referral,

consultation)

Pragmatic Reasons for Research Class **

Pragmatic Reasons for Research Class **

• Permit you to give informed presentations (written & oral) to civic groups

• Provide you skills for narrative reports & depositions

• Prepare you to conduct some practice based research for your profession

• Permit you to give informed presentations (written & oral) to civic groups

• Provide you skills for narrative reports & depositions

• Prepare you to conduct some practice based research for your profession

Teaching You to Fish

• The skills you will learn will help continue to learn after you graduate

– this is a skill set that most chiropractors and medical providers do not have

• Much of the information you learn in all your other classes will change..

• With the growing emphasis on evidence based practice, keeping informed is the key to a LOW RISK & SUCCESSFUL practice

History of Chiropractic History of Chiropractic Research and EducationResearch and Education

ObjectivesObjectives

• To understand the importance of research to the profession, doctor and patient

• To know the four periods of chiropractic history

• To know the major events of each period• To understand the significance of each period

• To understand the importance of research to the profession, doctor and patient

• To know the four periods of chiropractic history

• To know the major events of each period• To understand the significance of each period

Importance of research in chiropractic today*

Importance of research in chiropractic today*

• Importance to the profession

• Importance to the individual doctor– 80/10/10 rule– 1/2 of information

• Importance to your patients

• Importance to the profession

• Importance to the individual doctor– 80/10/10 rule– 1/2 of information

• Importance to your patients

EVIDENCED BASED PRACTICEEVIDENCED BASED PRACTICE

Periods of Chiropractic History**Periods of Chiropractic History**

• Period of Early Growth, 1895-1925– Dawn of the profession– Palmer School of Magnetic Cure 1896.– Oakley Smith 1899.– Palmer School– B.J. Palmer– Henry Herring

• Explosive growth

• Period of Early Growth, 1895-1925– Dawn of the profession– Palmer School of Magnetic Cure 1896.– Oakley Smith 1899.– Palmer School– B.J. Palmer– Henry Herring

• Explosive growth

1925*1925*

• 82 schools

• 28000 chiropractors

• 4000 students

• 82 schools

• 28000 chiropractors

• 4000 students

Periods of Chiropractic History Periods of Chiropractic History

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940

Period of Conflict**Period of Conflict**

• B. J. Palmer and the neurocalameter• Morris Fishbein and the AMA.• Great Depression• Purpose of research in the

profession– Reveal the will of God– Observation without experimentation

sufficient– Main role was in marketing

• B. J. Palmer and the neurocalameter• Morris Fishbein and the AMA.• Great Depression• Purpose of research in the

profession– Reveal the will of God– Observation without experimentation

sufficient– Main role was in marketing

1940*1940*

• 40 schools

• 15000 chiropractors

• 1400 students

• 40 schools

• 15000 chiropractors

• 1400 students

Periods of Chiropractic History*Periods of Chiropractic History*

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970

Period of Change**Period of Change**

• Committee on Educational Standards– Claude Watkins– John Nugent.

• Committee on Educational Standards– Claude Watkins– John Nugent.

1970*1970*

• 11 schools

• 15000 doctors

• 2500 students

• 11 schools

• 15000 doctors

• 2500 students

Periods of Chiropractic History***

Periods of Chiropractic History***

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970– 11/15000/2500

• Period of Professionalism, 1971-present

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970– 11/15000/2500

• Period of Professionalism, 1971-present

Period of Professionalism***Period of Professionalism***

• Prelude to the future– Chung Ha Suh, PhD.– NINDS.– US Office of Education

• Prelude to the future– Chung Ha Suh, PhD.– NINDS.– US Office of Education

1970’s***1970’s***

• 1973: First US government funding of Chiropractic research

• 1973: Chiropractic included in Medicare• 1974: CCE recognized by USOE• 1976: Wilk vs. AMA• 1978: JMPT first published• 1979: New Zealand Report

• 1973: First US government funding of Chiropractic research

• 1973: Chiropractic included in Medicare• 1974: CCE recognized by USOE• 1976: Wilk vs. AMA• 1978: JMPT first published• 1979: New Zealand Report

1980’s***1980’s***

• 1982: JMPT indexed by Index Medicus (NLM)

• 1982: First RCT of chiropractic for any health problem

• 1982: JMPT indexed by Index Medicus (NLM)

• 1982: First RCT of chiropractic for any health problem

1990’s***1990’s***

• 1991: First Rand Study published. Additional studies in 92, 94, 98

• 1994: “Federal Guidelines for Low Back Pain” published

• 1997: Consortium Center for Chiropractic Research Funded (2.7M)

• 1999: Inclusion of chiropractic care for all US military mandated

• 1991: First Rand Study published. Additional studies in 92, 94, 98

• 1994: “Federal Guidelines for Low Back Pain” published

• 1997: Consortium Center for Chiropractic Research Funded (2.7M)

• 1999: Inclusion of chiropractic care for all US military mandated

Periods of Chiropractic HistoryPeriods of Chiropractic History

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970– 11/15000/2500

• Period of Professionalism, 1971-present– 23/55000/15000

• Period of Early Growth, 1895-1925– 82/28000/4000

• Period of Conflict, 1925-1940– 40/15000/1400

• Period of Change, 1941-1970– 11/15000/2500

• Period of Professionalism, 1971-present– 23/55000/15000

George McAndrews***George McAndrews***

• “If the profession continues to publish theory, in the absence of scientific support, and continues to waste its funds on outrageous advertising rather than investigate the truth of the theory…the last 20 years will have been wasted.”

• “If the profession continues to publish theory, in the absence of scientific support, and continues to waste its funds on outrageous advertising rather than investigate the truth of the theory…the last 20 years will have been wasted.”