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Dynamic Chiropractic – July 1, 2011, Vol. 29, Issue 14

Committed to a Culture of Safety

Canadian initiative: create mechanism to report adverse events associated with SMT.

By Peter W. Crownfield, Executive Editor

The Canadian Institutes for Health Research (CIHR) has awarded $2 million to fund a five-year research project designed to develop a formal reporting mechanism to document adverse events associated with spinal manipulation.

The project brings together 22 Canadian researchers from four health disciplines whose scope of practice includes manipulation – chiropractic, physiotherapy, medicine and osteopathy.

Five of the 22 project members are doctors of chiropractic: Drs. Greg Kawchuk (one of five principal investigators), David Cassidy (co-investigator), Eric Hurwitz, Jay Triano (co-investigator) and Silvano Mior. Overall, the 22 team members represent five colleges: the University of Alberta, the University of Calgary, the University of Toronto, Canadian Memorial Chiropractic College and the University of Hawaii. Four Alberta regulatory colleges also will provide input.

"It's incredibly exciting to see this project get to the starting line," said Dr. Kawchuk when contacted by DC following the award announcement. "The effort involved was extraordinary. After years of planning, we have a 22-member research team whose expertise spans basic science, population research and health law. In addition, not only will the team be studying spinal manipulation, they will be doing it across the four professions in Alberta who are regulated to provide this intervention (chiropractic, physical therapy, medicine and osteopathy). Above all, these four professions need to be recognized and thanked for their enthusiasm and support of this truly multidisciplinary project."

Project Details

Four Health Disciplines - Copyright – Stock Photo / Register Mark The project is titled "CIHR Team in Safety Culture for Spinal Manipulation Therapy: (SAFETY NET: An Academic and Professional Partnership Building a Culture of Safety for Spinal Manipulation Therapy)." According to the project abstract posted on the CIHR site:

"High velocity/low amplitude (HVLA) spinal manipulation, a non-invasive manual procedure applied to specific body tissues with therapeutic intent, is the most common complementary and alternative medicine (CAM) practice in North America. Manipulation is most commonly provided by chiropractors although it is also provided by physiotherapists, physicians and osteopaths. At present, there is no formal reporting mechanism to document adverse events associated with HVLA manipulation. The study team aims to create a culture of safety around manipulation by developing instruments that practitioners can use to record and report adverse events. Volunteer community-based manipulation providers will pilot these tools through active surveillance with the goal of implementing the refined tools into the routine practice of manipulation providers. The ultimate goal of this team grant is to develop, pilot, evaluate and support a culture of safety for regulated professionals (chiropractors, physicians, physical therapists and osteopaths) who provide SMT in Alberta and Ontario. Our partners will not only help disseminate findings, they will apply the research findings to inform policies, programs and practice through their provincial regulatory responsibilities, and their strong ties with national associations and educational colleges."

Chiropractic Team Members and Principal Investigators

The five doctors of chiropractic involved in the project all have extensive experience in research settings. Dr. Kawchuk is a professor in the Faculty of Rehabilitation Medicine at the University of Alberta and Canada Research Chair in Spinal Function; Dr. Cassidy is a professor in clinical epidemiology in the Department of Health Policy, Management and Evaluation in the Faculty of Medicine, University of Toronto; Dr. Hurwitz is an associate professor, epidemiology, at the University of Hawaii; Dr. Triano is the dean of graduate education and research programs at CMCC; and Dr. Mior is a research scientist, Department of Research, and senior advisor to the president at CMCC.

Joining Dr. Kawchuk as principal investigators is a multidisciplinary group of researchers that includes Dr. Sunita Vohra, professor in the Faculty of Medicine & Dentistry at the U of A and Alberta Heritage Foundation for Medical Research scholar; Timothy Caulfield, professor in the U of A Faculty of Law and School of Public Health and Canada Research Chair in Health Law and Policy; Heather Boon, associate professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Maeve O'Beirne from the Faculty of Medicine at the University of Calgary.

"From everything we understand about patient safety, the best way to achieve it is through a multidisciplinary approach – this involves four different professions all of whom have one area that overlaps," said Dr. Vohra in a University of Alberta press release. "To the best of our knowledge, this is the first time that the four colleges have collaborated with each other in a research initiative. We're thrilled to work with the colleges of medicine, osteopathy, physical therapy and chiropractic."

According to the release, "All five researchers [the principal investigators] met at the U of A [on] May 19 with participants from the regulatory colleges as well as health-care providers, students and policy-makers to begin a dialogue around fine tuning the grant and its implementation." Look for further updates on this important project in DC as they become available.


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