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American chiropractors' research priorities
Abstract
IN 1996, THE UNITED STATES HEALTH RESOURCES AND SERVICES ADMINISTRATION awarded a contract to conduct a "National Workshop to Develop the Chiropractic Research Agenda." To inform that workshop, and to better understand their clinical environment, a representative mail survey of American chiropractors' research priorities was undertaken. The purpose of the study was to determine practicing chiropractors' needs and preferences relative to research both in general and in the short term. Scantron questionnaires were distributed by first class mail to a random sample of 2,280 chiropractors in the United States; 1,245 questionnaires were returned and analyzed. All participants were practicing chiropractors. Respondents used a five-category Likert scale to rate the relative importance of a menu of research objectives and topic areas. All rating percentages are presented, but the highest importance rating percentages are utilized for analysis. American chiropractors feel that the acceptance of chiropractic, primarily by patients and other health care professionals, should be the most important research objective. They feel that this can best be accomplished in the immediate future by basic science research on the nature of the subluxation complex and/or the physiological effects of adjustments including visceral and neuromusculoskeletal effects. In addition, very low priority was given to developing research resources, or to evaluating clinical techniques, procedures, or equipment.
... Compared to a sample of 1,245 American chiropractors in 1997 [14], respondents in our survey rate the value of research in different ways. (Table 4) Sixty-five percent of respondents to our survey view research as extremely important for the acceptance among other health care disciplines compared to 44% in the US survey. ...
... [13] Two questions about attitudes toward research were used from a survey administered to practitioners and chiropractic college faculty in the United States. [14,15] The questionnaire was pre-tested by Research Fellows at the Palmer Center for Chiropractic Research in Davenport, Iowa and clinicians at the Palmer Clinic in Rock Island, Illinois. Comments and critiques were incorporated into the final version of the questionnaire. ...
In 2004, a survey conducted by the European Chiropractor's Union among member countries reported that "there appears to be little interest in research among chiropractors in Germany." However, no research has tested this statement. The objective of this study was to explore the attitudes and perceptions of practicing chiropractors in Germany regarding research, to look at their reading and research habits, and to gather demographic and practice data.
A questionnaire was developed and distributed among participants at a seminar held by the German Chiropractors' Association in 2005. The questionnaire was mailed to any members of the association who did not attend the seminar.
A total of 49 (72%) of 68 distributed questionnaires were returned. Forty-five (92%) respondents stated they would support research efforts in Germany and 15 (31%) declared interest in participating in practiced based research. An average of three hours per week were reportedly spent reading scientific literature by 44 (85%) respondents. However, few journals listed by respondents were peer-reviewed and indexed; most were newsletters of chiropractic organizations or free publications. Most participants agreed on the importance of research for the profession, but when asked about the most pressing issue for chiropractic in Germany, legislation and recognition of the profession were the dominant themes.
The results of this survey show that there is a general interest in supporting and participating in research activities among chiropractors practicing in Germany. Next steps could consist of educating practitioners about the resources available to read and interpret the scientific literature and thus further the understanding of research.
... The study does, however, provide direction for a profession that is seeking to establish a research agenda and has substantial limitations in funding and capable personnel. 31 Posterior ...
Objective:
To rate specific chiropractic technique procedures used in the treatment of common low back conditions.
Design and methods:
A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process.
Results:
For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain.
Conclusions:
The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.
This article describes the recruitment and retention methods of chiropractors who participated in three projects in a practice-based research program and reports on a survey of their opinions and experiences. Participants were recruited through the assistance of professional leaders, chiropractic publications, and personal communication with program staff. Retention methods included providing training to chiropractors and their staff, mailing summary reports following each project, certificates of appreciation to chiropractors and staff, chiropractors' names being included in the acknowledgments of the published articles, and continued personal contact with the program coordinator. A total of 289 chiropractors from 236 practices located in 44 states, Canada, and Australia participated in the program. Of the 266 mailed surveys, 216 (81%) were returned. Most of the respondents reported that both they and their patients had a positive experience with research as a result of their participation, although time was identified as the largest barrier to their involvement. Factors that impact participation in practice-based research include support from professional leaders, project content, and the amount of disruption to the practice due to project demands.
Many chiropractors treat patients with spinal adjustments based on the theory that correction of vertebral subluxations will restore and maintain health. This paper explores the controversy surrounding the practice of chiropractic and discusses some of the dangers associated with inappropriate use of spinal manipulation. Treatment of infants and children by subluxation-based chiropractors who do not endorse such medically accepted procedures as immunization or use of antibiotics is especially a cause for alarm. Explaining the scientifically rejected chiropractic subluxation therapy and describing some of the questionable treatment methods based on this theory, a veteran chiropractic reformer concludes that if the chiropractic profession fails to abandon the false premise upon which it is based, it will remain controversial and some aspects of chiropractic treatment will continue to be a threat to public health.
Objective: To rate specific chiropractic technique procedures used in the treatment of common low back conditions.
Design and Methods: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process.
Results: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain.
Conclusions: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.