If you have a burning desire to research something, it's unlikely that you will be able to call up some smart person you've heard of and get them to drop their life's work and start researching what you are interested in just because you think it's really important. People do research on subjects that interest them. If a researcher doesn't have the expertise or money to do it alone, the researcher has to call on his or her resourcefulness and go about trying to find what is needed. Writing grant proposals to get funding in order to conduct a research project is hard work in and of itself.
Only a small number of people are able to give up their day job and live entirely off of the soft money that can come from a research grant. Before a single cent of grant money shows up, you must get the design through human subject review boards, then through a grant review processes. Even then, only a small portion of projects will actually get funded.
Finally, after a project is designed, funded and implemented, the data from the project is collected and analyzed - and maybe, just maybe, something pans out. Often times it doesn't; there is too much missing data, or there are unexpected problems, like an inability to recruit enough subjects, the effect size was smaller than expected and no significant differences can be measured, or the results didn't come out the way they were hypothesized. So, you write up your findings to share with the world. Frequently the articles are rejected, and researchers spend months submitting them to journals - with their inherent procedural delays and review processes - before they finally see the light of day.
OK, so I'm making a strong case that doing research is really tedious, difficult, lengthy, and frequently thankless work - which brings me to the point of this column. If one is actually going to put the energy and resources into conducting research, it is important to make sure it's worth the effort and will contribute to our knowledge base in meaningful ways. What priorities should the chiropractic world set for engaging this challenging scientific enterprise?
Nearly 10 years ago, some folks at the Palmer Center for Chiropractic Research obtained a federal grant to run a conference in which chiropractic scientists, scholars, practitioners and other leaders gathered to determine the domain of what was known in the basic sciences, clinical practice, educational research, and health service research related to chiropractic. Teams met to prioritize specific research needs the profession had in each of these areas. A series of five papers were ultimately published in the Journal of Manipulative and Physiological Therapeutics in 1997 with the recommendations from this effort.
Perhaps the most important common thread in all of the papers was the need for improving chiropractic's research infrastructure - meaning the number of people and places doing research, and the skills of those conducting it. Researchers at the Palmer Center have managed to continue their hard work to get ongoing annual funding in order to send faculty from all of our colleges to an annual Research Agenda Conference to get training and share expertise.
It has been almost a decade since the profession underwent that original research prioritization exercise, and as a result, teams have once again convened to review what progress has been made in each of the areas and make new recommendations for the future. The review is taking place right now; recommendations will be finalized at the next Research Agenda Conference (RAC) in Las Vegas in March 2005.
Subject areas of interest to the researchers in attendance get due consideration, but professional leaders, scholars, and practitioners will also have an opportunity to provide input. In addition to research questions that are of interest to chiropractors being considered, research concerning chiropractic, which is of importance to others in health care and policy arenas, will need consideration.
As a health services researcher by day, some of my most burning research questions awaiting answers include:
- What is the optimal frequency and duration of chiropractic care for various conditions?
- How do meaningful patient outcomes compare between different chiropractic techniques?
- How does combining chiropractic adjusting, with other interventions (lifestyle modification or exercise) affect outcomes?
- What can be done to improve the effectiveness of chiropractic care, including the speed and magnitude of recovery?
- What "best practices" should chiropractors adopt to assure better outcomes for their patients?
The list could go on, and every other chiropractic researcher is sure to have plenty to add. Next year's RAC is everybody's opportunity to focus on what our research priorities should be. While we can reflect on how far the profession has come with a great deal of pride, we must keep our eyes on the future. The fact is, we have nowhere near enough researchers within chiropractic to do all the work that needs to be done. As I mentioned previously, research is a tedious, difficult and frequently thankless enterprise that takes a lot of dedication to pursue.
For more information about the 2005 Research Agenda Conference, check the Palmer Center for Chiropractic Research home page (www.palmer.edu/PCCR/PCCRhome.htm) for links to the latest conference information as it becomes available.
Robert Mootz, DC
Associate Medical Director for Chiropractic,
State of Washington Department of Labor and Industries
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