One of the problems with having such a small research community within the chiropractic profession is that we are fairly limited in the number of research studies we are able to conduct. To put it in perspective, the Palmer Center for Chiropractic Research (PCCR) has approximately 30 full-time employees and spends about $5 million per year. At any given time, we have around 12 studies in progress, not including those in the planning and development phase. Each project takes somewhere between 3-6 years to complete. Thus, the largest research effort in the U.S. is only able to tackle 1-3 new studies each year.
By now you are surely asking, how could that could be possible? Well, there are many moving parts to a research project. Once you have a general question – for example, "Is the way you treat back pain better than the way a physical therapist or a family practice doctor might treat back pain?" – you have to figure out how to answer the question. This process is very complex.
To give you some idea, here is an example of one of the simplest kinds of studies out there – a survey. Let's say you want to survey a group of people about their attitudes regarding the chiropractic profession. What would it take to do this? The short answer: write a question or two, ask those questions to a few people and look at the results.
That's true, but let's also take a look at the long answer. Here are some of the issues you would have to grapple with before you could conduct the survey:
This is just a quick list off the tops of our heads. We know from previous experience that there are many other considerations that also need to be taken into account. And this is for a simple survey! Imagine the complexity of a clinical trial in which you have 200 people randomized to two groups: one of whom receives three adjustments for four weeks, while the other group receives some other intervention on a different treatment schedule.
And you are collecting pain and disability scores at each visit, and you are doing biomechanical testing once per week. And people will be coming in to the study over the course of six months, and you need to do baseline testing to see if they meet eligibility criteria, etc. It is a tremendous undertaking.
By now you may be wondering exactly what the point of this month's column might be. The point we are trying to make is that for every research question we ask, we are well-aware that there are so many more questions which need to be answered. Answering those questions takes money, time and energy, all of which are limited.
Given the exceedingly scarce research resources within the chiropractic research community, we want to make sure we are asking questions that provide you, the clinician, with information you are able to use as you engage in patient management. We want to help you better critically appraise articles, and to look critically at information as you decide whether or not you trust it enough to put it into use.
We are all working together to help our chiropractic patients receive the best care possible. And what we (the collective "we") want to know, for any paper, is whether or not that information can be applied to patient care.
So, we implore you: Contact us [see blog address below]. Let us know what research you are interested in and what your scientific concerns or questions are. We can help you better understand how to approach your question, find answers, and in the end, apply it to your patients. We look forward to hearing from you.
To learn more about Drs. Lawrence and Goertz, visit their columnist page. The column includes an affiliated blog where chiropractors can post questions for the authors.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
