4.1 INTRODUCTION
Chiropractic research in a legitimate scientific and sustained manner is a relatively recent occurrence.[1] So commences the treatise of Drs Reed Phillips, Alan Adams and Ruth Sandefur in the ninth chapter of the comprehensive publication of the Agency for Health Care Policy and Research entitled ’Chiropractic in the United States: Training, Practice, and Research’ along with other members of the chiropractic profession, who take an interest in history, they recognize the scholarship of Keating, in bringing together accurate details relating to the profession. [1]
In dealing with the ’History and Development of Research‘, Phillips et al [1] mention the establishment of bodies that carried the term ’Research’ as part of the name of their Foundation which may have existed to raise funds for research but usually ended up directing accumulated finance to support the educational base of chiropractic within their own institution or those institutions which adhered to the tenens of chiropractic which they supported.
4.1.1 THE EARLIEST DAY
The early years of chiropractic research are characterized by individuals such as Carver [2], [3], Logan [1], Watkins [5] and Weiant. [5], [6] These individuals’ lives and contributions have been studied in detail elsewhere. [2], [3], [4], [5], [6], [7].
4.2 INTO THE FIFTIES: AN ERA OF SIGNIFICANT RESEARCH
The chiropractic profession in Canada has a rich history of having been investigated through Government Inquiries or Royal Commissions right back to the second decade of the 20th century [See Chapter 1].
On the Website of ’Planetchiropractic.com‘ under the Category of Chiropractic Schools Canada a comprehensive description is provided of the Canadian Memorial Chiropractic College [CMCC]. Under the heading of CMCC History we find evidence of a 1944 meeting of the Dominion Council of Canadian Chiropractors which concluded that Canada needed an institute that would provide a high standard of research and education in chiropractic. [8], [9]
It appears that it took until the 1950s however, before meaningful research into various aspects of chiropractic practice, from within the College or from members of the profession involved with the college, emerged or was reported. By that time the Foundation for Chiropractic Research (FCR) had been established in the USA by the National Chiropractic Association, but little was reported from that source on meaningful research.
In 2001 the Journal of the Canadian Chiropractic Association carried a comprehensive paper that profiles ’Dr. Lyman C Johnston DC FICC FCCS[C] as: Canadian chiropractic’s postural research pioneer and inventive entrepreneur’ submitted to the Journal by Douglas M Brown. There in we find clear details of the significant research conducted by Dr. Johnston and his fellows which covered postural concepts, protocols for treatment and diagnostic and therapeutic devices [10].
4.3 THE 1960S: EDUCATIONAL STANDARDS UPGRADED; THE 1970S: FEDERAL FUNDING FROM NIH
As Phillips et al [1] have explained, when in the 1960s chiropractic educators realised the urgent necessity to upgrade educational standards so that their individual programs might achieve nationally recognized accreditation the Chiropractic Research Foundation [CRF] changed its title to reflect more clearly its role as a support for educational bodies pursuing accreditation. It became the Foundation for Accredited Chiropractic Education. In due course it ’was reorganized as the Foundation for Chiropractic Education and Research (FCER).’That was in 1967. [1]
4.3.1 DR. SUH AND THE UNIVERSITY OF COLORADO PROJECT
Chung Ha Suh, Ph.D., and colleagues at the University of Colorado began a series of studies in the Biomechanics department in the 1970s which produced a large volume chiropractic-related scientific research. These studies were funded by grants for the International Chiropractors Association (ICA), American Chiropractic Association (ACA) and also the USA Federal Government. [10], [11]
There were two major research projects at the University of Colorado. The first project involved Dr. Suh in creating a cervical spine computer model to enhance the understanding of joint movements and the impact of the chiropractic adjustment. [10]
The second project was a study of the effects of spinal nerve root compression Conducted by Dr. Seth Sharpless and Dr Marvin Luttges and their colleagues they showed that even minute pressure on a nerve root caused electrical activity in the nerve to decrease by up to 50 percent. The pressure in the study was only 10mmHg, equivalent to a feather falling on your hand. [10]
4.4 SCOPE OF RESEARCH AND EFFORTS TO DEVELOP A CHIROPRACTIC RESEARCH AGENDA
4.4.1 BEFORE THE RESEARCH AGENDA CONFERENCE
In the 1997 publication ’Chiropractic in the United States: Training, Practice, and Research‘ in the chapter devoted to Chiropractic Research [Chapter IX] Phillips set al [1] make reference to the Proceedings of the National Workshop to Develop the Chiropractic Research Agenda, with the comment that the scope of chiropractic research paralleled medical research despite the small numbers engaged in research.’[1]
4.4.2 THE RESEARCH AGENDA CONFERENCE
The Research Agenda Conference (RAC) began as a solo event in 1996. Early announcements of this conference appeared in ’Dynamic Chiropractic‘– [December 18, 1995, Vol. 13, Issue 26]. [12]
Under the heading ‘Palmer Awarded Federal Contract to Set Chiropractic Research Agenda’ the announcement included details that a contract from the U.S. Health Resources and Services Administration (HRSA) for a project titled, “A National Workshop to Develop the Chiropractic Research Agenda” had been awarded to Palmer college of Chiropractic. The project was focused on determining the priorities for the chiropractic research and required the formation of an interdisciplinary panel. The project has the support of both the Foundation for Chiropractic Education and Research (FCER) and the Consortium for Chiropractic Research (CCR). [12]
4.4.3 PALMER COLLEGE OF CHIROPRACTIC REPORT
As explained in the ‘Abstract’ of an article submitted to the Journal of Manipulative and Physiological Therapeutics (JMPT) [13]: A national meeting was held on July 12-14, 1996 to develop a research agenda for chiropractic to increase the research output by the profession. The major result of the workshop was the publication of some position papers. A consensus on the research agenda was not met so the project was renewed for a further year.
4.4.4 NATIONAL COLLEGE OF CHIROPRACTIC LOMBARD, ILLINOIS
The article submitted from Palmer College to the JMPT regarding the first RAC event was followed immediately (on pages 150 to 168 of the same edition) by an article entitled ‘Basic science research in chiropractic: the state of the art and recommendations for a research agenda’. This was authored by Brennan PC, Cramer GD, Kirstukas SJ, and Cullum ME of the Department of Research, National College of Chiropractic, Lombard, Illinois. According to the Abstract, this was [14]: an article that discussed the history of basic science research in the profession and also highlighted the current state of affairs since 1975.
4.4.5 LOS ANGELES COLLEGE OF CHIROPRACTIC, WHITTIER, CALIFORNIA
Following the reports from Palmer College and National College (on pages 179 to 184 of the same 1997 Mar-Apr edition of the JMPT) was a report entitled ‘The State of the art of research on chiropractic education’.
The Los Angeles College of Chiropractic had reviewed the current (Note: 13 years ago) status of research on chiropractic education, including barriers to chiropractic educational research and [looked to] provide recommendations for future research activities.’
The study found that most studies in education are descriptive with no external funding sources. Based on the results, the study recommends that chiropractic educational research needs to develop its theory and science through defining research issues and then using the proper methods to study the issues [15].
It can now be clearly shown that the recommendations or hopes and aspirations of the authors of this study and the previous two submitted to the JMPT In 1997 have been adequately addressed.
4.5 RESEARCH IN CHIROPRACTIC COMES OF AGE
It must be said that the discourse on Chiropractic Research compiled by Dr Reed Phillips et al, has adequately covered the history of development of the various sources of funding that have developed within the United States of America over the last quarter of a century [1].These agencies that have been established and have contributed funds to support research and research conferences have however looked to the profession or its close supporters for their financial backing. In times of financial crisis it is inevitable that the source of funding may dry up; and that does appear to be the case with one highly regarded agency.
It continued to be the major channel for donated funds from members of the chiropractic profession and various ancillary bodies within the USA that supported the profession in its quest for meaningful research right into the twenty first century. Eventually government agencies emerged with the responsibility to provide such funding and for the first time public funding came to exceed that which could be provided through the FCER.
4.5.1 THE FOUNDATION FOR CHIROPRACTIC EDUCATION AND RESEARCH (FCER) USA
The FCER ceased to exist in 2009. The following report from the American Chiropractic Association tells the whole story [16]:
FCER Legacy: Research Excellence As FCER closes its doors, the profession discusses the past and future of chiropractic research.
The FCER existed for more than 60 years and funded $11 million of chiropractic research, as well as a further $20 million in federal research grants. FCER ultimately closed due to financial issues brought about by the recession of 2008.
FCER was very active since the 1975 National Institute of Neurological Diseases (NINDS) Conference to push the chiropractic research agenda. FCER was a leading organization for following scientific ideals of objective testing and peer-reviewed publishing. FCER’s influence was so widespread that almost all major research papers related to chiropractic have originated from a research that was funded either directly (by fellowship) or indirectly by FCER.
Much of the research funding for FCER activities came from private enterprises such asNCMIC, Foot Levelers, Standard Process, NBCE and others.
FCER’s greatest impact seems to have been through providing funding to chiropractors to undertake advanced study at PhD level. These researchers attained skills that allowed them to then source funding from the NIH.
4.5.2 OTHER CHIROPRACTIC RESEARCH AGENCIES IN THE USA
Again we turn to the comprehensive document prepared by Dr. Reed Phillips and his co-authors to obtain details on other sources of research funds that have been established and developed within the chiropractic profession. The following extracts are adapted from their chapter on ‘Chiropractic Research’ or from other indicated sources. [1]
a. The Consortium for Chiropractic Research
The Consortium for Chiropractic Research (CCR), has awarded over $660,000 to support four projects since 1990:
- The appropriateness of spinal manipulation of the cervical spine,
- The role of chiropractic in meeting rural health care needs, and
- Randomized trials of the effect of chiropractic on chronic neck pain and
- childhood asthma [1].
b. The Foundation for the Advancement of Chiropractic Education
Established since 1981 by Dr. William Harris, a chiropractor in private practice. FACE has provided more than $3 million for research in chiropractic. FACE has provided funds not only for projects but also to create infrastructure at colleges as well as supporting FCER and the National Institute of Chiropractic Research (NICR).[1]
c. National Institute of Chiropractic Research
The National Institute of Chiropractic Research (NICR) was founded in Minnesota in 1987 by Dr Arlan Fuhr. The organization aims is to raise funds for research and scholarship in chiropractic. The NICR itself conducts research, as well as providing funding to other projects. [17]
The NICR has funded projects to study the kinematics of adjustments and leg length inequalities as well as education reseach and jointly funded three studies with the FACE. [16]
NICR has also awarded funds to researchers at Chiropractic colleges and the Association for the History of Chiropractic. [17]
d. National Chiropractic Mutual Insurance Company
The National Chiropractic Mutual Insurance Company (NCMIC) alongside the FCER have co-funded numerous studies. In particular studies on clinical problems and the effect of chiropractic care. Clinical problems studied include dysmenorrhea, carpal tunnel syndrome, hypertension, and otitis media. Together FCER and NCMIC have granted almost $2 million to research.[1]
e. Lincoln College Education and Research Fund, Inc.
The Lincoln College Education and Research Fund, Inc. (LCERF), was founded in 1979 to help advance chiropractic science. LCERF has funded scholarships as well as a research chair at Florida State University. [1]
4.5.3 FEDERAL AGENCIES
- The Agency for Health Care Policy and Research (AHCPR)
AHCPR awarded Group Health Cooperative of Puget Sound $980,000 in 1983 to perform a comparative trial of chiropractic, McKenzie physical therapy, and an educational booklet for low back problems. AHCPR has also awarded UCLA $1.8 million to again compare chiropractic, physical therapy, and regular medical care for low back pain. [1]
- The Health Resource and Services Agency (HRSA)
HRSA has provided over $2 Million of funds for three projects. These projects studied the biomechanics of flexion-distraction therapy, low back pain management with manual therapy and patient outcome for low back pain in practice. [1]
The following rather lengthy and detailed document (available via link) is shows the thoroughness of the process used to ensure that United States Government funds are only provided for valid research projects conducted by well qualified applicants, who in this case wish to pursue studies applicable to the practice of chiropractic. The document is of course somewhat dated.
Within this document some history of the establishment of the Office of Alternative Medicine is given and reference is made to a “Healthy People 2000” project which may have been long forgotten but with the ongoing programs now directed through the National Center for Complementary and Alternative Medicine (NCCAM), [a component of the National Institutes of Health] any objectives, which may involve alternative medical health care may be met. Notes relating to the function of the NCCAM follow directly after this document.
It could well be worthwhile that any person, who might wish to pursue “Foreign Research Opportunities” related to chiropractic, take the time to visit the appropriate NIH website to examine the advice given therein. *
*URL: http://grants.nih.gov/grants/foreign/index.htm
- National Center for Complementary and Alternative Medicine
NCCAM-Funded Research
Recent research projects on chiropractic care supported by the National Center for Complementary and Alternative Medicine (NCCAM) have focused on the:
- Effectiveness of chiropractic treatments for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders.
- Development of a curriculum to increase the number of chiropractors involved in research.
- Influence of people’s satisfaction with chiropractic care on their response to treatment. [20]
| Institute | Years | Fund/Dollars Awarded | Number Awarded | Comments (Awardee) |
| University of Western States (Formerly Western States Chiropractic College untill 2010) | 2011 | $932,104 | 2 | Haas, Mitchell |
| 2010 | $681,834 | 2 | Haas, Mitchell | |
| 2009 | $741,285 | 2 | Haas, Mitchell | |
| 2008 | $855,194 | 2 | Haas, Mitchell | |
| 2007 | $853,847 | 2 | Haas, Mitchell | |
| 2006 | $892,330 | 2 | Haas, Mitchell | |
| Canadian Memorial Chiropractic College | 2011 | NIL | ||
| 2010 | NIL | |||
| 2009 | $109,174 | 1 | Triano, John J | |
| 2008 | $290,753 | 2 | Vernon, Howard T, Triano, John J | |
| Palmer Chiropractic University | 2011 | $1,113,022 | 2 | Goertz, Christine M; Reed William R |
| 2010 | $2,284,117 | 4 | Pickar, Joel G; Long, Cynthia Goertz, Christine M; Reed William R | |
| 2009 | $5,180,025 | 5 | Pickar, Joel G; Long, Cynthia Goertz, Christine Marie; | |
| 2008 | $1,434,661 | 4 | Goertz, Christine M:Smith Monica M; Pickar, Joel G | |
| 2007 | $1,198,498 | 3 | Goertz, Christine M:Smith Monica M; Pickar, Joel G | |
| 2006 | $725,937 | 3 | Meeker, William C; Smith, Monica M; Long, Cynthia R; Pickar, Joel G | |
| 2005 | $1,391,222 | 4 | Meeker, William C; Smith, Monica M; Pickar, Joel G | |
| 2004 | $1,563,526 | 4 | Smith Monica M, Meeker, William C; Pickar, Joel G. | |
| 2003 | $816,559 | 4 | Henderson, Charles N; Meeker, William C; Pickar, Joel G | |
| 2002 | $1,149,747 | 3 | Meeker, William C; Pickar, Joel G | |
| 2001 | $1,018,931 | 5 | Meeker, William C | |
| 2000 | $1,972,757 | 2 | Meeker, William C | |
| 1999 | $785,867 | 2 | Meeker, William C | |
| 1998 | $629,069 | 1 | Meeker, William C | |
| 1997 | $500,000 | 1 | Meeker, William C |
4.5.4 The Palmer Center for Chiropractic Research (PCCR)
The PCCR was established in July 1995 to combine the resources of Palmer College in Davenport, Iowa and that of Palmer West in San Jose in California. Since that time it has also added the facilities of Palmer Campus in Port Orange, Florida.
The PCCR is the largest research facility in the world to be established within a chiropractic college. At the time the “Overview” article from which these details are derived was made available on the Internet, it had a full-time staff of 14 along with eight associate faculty members plus 19 technical and administrative staff members.
As can be deduced from the details on NIH contributions tabulated above, the Center has the largest budget for research in a chiropractic educational institution ’supplemented increasingly by grants from outside sources. The National Center for Complementary and Alternative Medicine [NCCAM] at the National Institutes of Health, [NIH] the Health Resources Service Administration (HRSA), and in the past the Foundation for Chiropractic Education and Research [FCER]. [21], [22]
“These funds, totaling millions of dollars, have been instrumental in expanding PCCR programs in research education, clinical science, experimental biomechanics, neurosciences and health services and policy research. In October 2002, the PCCR became the first chiropractic institution to be awarded a federal grant to expand its clinical and research facility, which now includes 16,400-square feeton five floors.”
Continually focused on increasing its financial base for research, the PCCR has already achieved several historical firsts:
- First chiropractic institution to receive a grant directly from the federal government to establish a formal research center
- First chiropractic organization to receive a contract to establish an annual national research conference
- First chiropractic institution to be awarded a federal grant to expand its facility
- First chiropractic institution to receive a research curriculum grant for providing master’s of science degree training of chiropractors in high-level clinical research
Highlights of some ongoing PCCR programs
- The Center for the Study of Mechanisms and Effects of Chiropractic Adjustments is a collaborative, three-year project with National University of Health Sciences, Kansas State University, State University of New York at Stony Brook, and the University of Iowa to establish a multidisciplinary developmental center for the study of mechanisms and effects of chiropractic care. It is supported by the National Center for Complementary and Alternative Medicine of the National Institutes of Health.
- Educational Research is focused on studies to evaluate and improve chiropractic education.
- Experimental Biomechanics and Neurosciences Research includes basic science oriented studies relevant to chiropractic theory and practice.
- Health Services and Policy Research concentrates on studies of high-priority health policy issues involving utilization, cost, quality and access as it relates to chiropractic healthcare delivery [23]
4.5.5 REGULAR RESEARCH CONFERENCES
In 2002 the announcement was carried in Dynamic Chiropractic that the Research Agenda Conference and the Association of Chiropractic Colleges annual meeting would be held together. The four day meeting provided workshops and presentations on clinical, academic and research matters. [24]
4.5.6 THE ASSOCIATION OF CHIROPRACTIC COLLEGES: ANNOUNCING EVENTS
The purpose and format of the ACC-RAC 2012 conference was presented by the Association of Chiropractic Colleges (ACC) on its web-site prior to the event. The ACC meeting was focussed on teaching, administration and course structure for the colleges. The Research Agenda conference (RAC) was composed of workshops with development of scientific knowledge as the key outcome. [25]
4.5.7 A PROMPT REPORT FROM THE JMPT ON ACC & RAC EVENT
A brief description of proceedings of ’The Association of Chiropractic Colleges Educational Conference and Research Agenda Conference: 17 years of Scholarship and Collaboration‘ held in Las Vegas, Nevada from March 18th to 20th has been presented as an editorial in the March 2010 edition of the Journal of Manipulative and Physiological Therapeutics. [26]
Johnson and Green explain the origins of the RAC and what it now focuses on [26]:
First held in 1996, the Research Agenda Conference (RAC) aimed to increase the research capacity of and guide the future research for the chiropractic profession. RAC received funding from the US Department of Health and Human Services for ten years.
The RAC part of the conference involved plenary sessions and workshops. Plenary sessions aim to discuss pertinent topics in the science of chiropractic. The workshops focus on skill development such as how to write articles and incorporate research into practice.
The ACC has a Peer-review Committee tasked with ensuring high integrity and scholarship occur at the conference. They also seek to get more published articles, more peer-reviewers and more scholarship chances arise from the conference. They also have a mentoring role to authors and reviewers. The scientific, peer-reviewed topics cover 4 main areas, namely basic science, clinical research, education research and the conference theme topic for the year, e.g. public health.
It should be noted that a total of 93 papers were accepted for Platform Presentation and that Abstracts of the ACC Conference proceedings are available in the Journal of Chiropractic Education 2010; 24(1). The Journal is available online at the following URL:
http://www.journalchiroed.com/current_issue.htm
4.6 BEYOND THE UNITED STATES OF AMERICA
4.6.1 CANADA AND THE FIRST CHIROPRACTIC RESEARCH CHAIR
In July of 2001 Dr Allan Gotlib, the research programs coordinator for the Canadian Chiropractic Association (CCA) announced the appointment of Canada’s first Chiropractic Research Chair. As reported in Dynamic Chiropractic [27]:
Greg Kawchuk, DC, PhD, based at the University of Calgary (UC) is the first recipient. The research chair is funded by the federal government of Canada and is specifically devoted to chiropractic research. The chair has been set up in accordance to guidelines from the Canadian Institutes of Health Research (CIHR), the Canadian Chiropractic Association (CCA), the Canadian Chiropractic Research Foundation (CCRF), and the Foundation for Chiropractic Education and Research (FCER).
Dr. Kawchuk’s research investigations will be targeted at enhancing knowledge in three keys areas. Those are measurement of treatment dosage, treatment outcomes, and treatment complications. Briefly Dr. Kawchukis a 1990 graduate of Canadian Memorial Chiropractic College (CMCC). He also holds a master’s thesis in biomechanics from UC, and a PhD in bioengineering.
SEE ALSO:
Canadian Chiropractic Research Bulletin. Bulletin #16. December 15, 2008. Available from: URL:http://www.docstoc.com/docs/11468381/Canadian-Chiropractic-Research-Bulletin/
4.6.2 RESEARCH: ACADEMIC INTEGRATION
1. The Canadian Memorial Chiropractic College (CMCC)
CMCC is recognized as leader in chiropractic research, having been active for more than 50 years. CMCC faculty members have been involved in collaborative research efforts with resarchers at many universities throughout North America.. An example a major project undertaken is the 2003 project of almost $2 million to CMCC by the Ontario Ministry of Health and Long-Term Care to create a collaborative inter-disciplinary model of, practice [28].
2. The CMCC 2006-2009 Research Report: Resetting the Research Paradigm
The title of this document is certainly appropriate and the full text complete with introductory comment from the College President is worthy of study by anyone who might take a genuine interest in what is happening in research within a well-established chiropractic academic environment. [29]
3. Consortium of University-Based Research Centres
IN 1998, the Canadian Chiropractic Association (CCA) formed the Consortium of Canadian Chiropractic Research Centres (CCCRC). The CCCRC is composed of CMCC and twelve university- research sites with chiropractic researchers doing inter-disciplinary research, holding faculty positions or undertaking further research training.
The CCCRC, together with the Canadian Institute of Health Research (CIHR) have also created University Chiropractic Research Chairs. [28]
4. International collaboration
The Canadian Chiropractic Association (CCA) is part of member of the Canadian Cochrane Network with member the chiropractic profession serving within the Executive Committee. Other international projects involving the CCA include the World Health Organization’s Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders.[28]
5. Researchers
Research funding for chiropractic researchers comes from many agencies. Amongst them are the:
- Canadian Institutes of Health Research,
- Natural Sciences and Engineering Research Council of Canada,
- Health Canada,
- Ontario Ministry of Health and Long-Term Care,
- Industry Canada,
- Alberta Provincial CIHR Training Program in Bone and Joint Health,
- Canada Primary Care Transition Fund
Areas of research interest include biomedical and clinical sciences, health systems and services, and social cultural. Publication of research findings occurs within chiropractic and non-chiropractic peer-reviewed journals. For example the Journal of the Canadian Chiropractic Association, Journal of Manipulative and Physiological Therapeutics, New England Journal of Medicine, the Lancet, Spine, and the Archives of Physical Medicine and Rehabilitation.[28]
6. Building a research culture
Supporting chiropractors to undertake Masters and PhD degrees and other research is one of the main tasks of the Canadian Chiropractic Research Foundation (CCRF).
Funding for doctoral and fellowships has also been provided to the profession through a partnership with the Canadian Institutes for Health Research (CIHR). [28]
7. Chiropractic research agenda
The national chiropractic research agenda in Canada has been developed since 2000 with the help of funding from the Canadian Institutes of Health Research: the Institute of Musculoskeletal Health and Arthritis, the Institute of Aging, the Institute of Neuroscience, Mental Health and Addiction, and the Institute of Population and Public Health. [28]
The ’CIHR CCRF Workshop to advance the Chiropractic Research Agenda‘in Canada took place in Montreal on October 1-2, 2009. The Workshop was funded by the Canadian Institutes of Health Research (CIHR), the Canadian Chiropractic Research Foundation (CCRF), the Canadian Chiropractic Association and the Canadian Chiropractic Protective Association. Members of the consortium work at many different universities across Canada. The objectives of the workshop were to [30]:
a) Refine the Chiropractic Research Agenda. Through presentation of the most recent research developments in the profession.
b) Bring together members to build relationships to assist in strengthening future research opportunities.
c) Develop a plan for transference of knowledge and address barriers to stakeholders use and implementation of the knowledge.
The workshop facilitators invited Provincial Association representatives to attend with the hope of fostering enhanced collaboration as well as gaining mutual understanding of context issues..
Note: Also see the following URLs:
- Research Consortium Workshop III to advance the Canadian Chiropractic Research Agenda by Dr. Kent Stuber, Dr. André Bussières and Dr. Allan Gotlib. J Can ChiroprAssoc 2009 March; 53(1): 7–13. Available from: URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652625/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652625/pdf/jcca-v53-1-007.pdf
- Chiropractic Around the World; WFC Quarterly Country Reports. Dynamic Chiropractic Canada 2010 Mar;3 (02). Available from:URL:http://www.dynamicchiropractic.ca/mpacms/dc_ca/article.php?id=54511
- Chiropractic research capacity in Canada in 2008 – Phase 3 by Stuber K, Bussières A, Gotlib A.Available from:URL:http://www.jcca-online.org/ecms.ashx/PDF/2009/2009-4/EntireJCCAv534.pdf
8. University chairs in chiropractic
The University Research Chair program was formed by the chiropractic profession with funding assistance from CIHR. The first chair was awarded to Dr. Greg Kawchuk, and he went on to later receive a Canada Research Chair at the University of Alberta.
In 2003 the second chair at the University of Toronto was awarded to Dr. Mark Erwin. He was conducting research on spinal disc degeneration. The Canadian Chiropractic Research Foundation (CCRF) has awarded a Professorship in Spine Biomechanics and Neurophysiology at the University of British Columbia (UBC) to Dr Jean-Sébastien Blouin [27].This award is funded by the CCRF, UBC, the British Columbia Chiropractic Association (BCCA) and the British Columbia College of Chiropractors (BCCC) and provides a five-year, full-time position.
A Chiropractic Research Chair at the Université du Québec a TroisRivières, funded by The Fondation de Recherche Chiropratique du Québec and Platinum Systems has been awarded to Dr. Martin Descarreaux. His research will focus on muscle fatigue and pain with head/ neck movements.
The CCRF/CIHR Chair at the Toronto Western Research Institute was awarded in 2007 to Dr. Jill Hayden DC, PhD. She works on low back pain prognosis and disability outcomes research.[30]
9. Current University-based Research Chairs Now and Near Future
Dr. Greg Kawchuk DC, PhD at the University of Alberta, Dr. Mark Erwin DC, PhD at the University of Toronto, Dr. Jean-Sébastien Blouin DC, PhD at the University of British Columbia, Dr. Martin Descarreaux DC, PhD at Université du Québec à Trois-Rivières, and Dr. Jill Hayden DC, PhD at the Toronto Western Research Institute, University Health Network.
UPDATE: Dr Jill Hayden is now Chiropractic Research Chair and Assistant Professor, Department of Community Health and Epidemiology, Faculty of Medicine at Dalhousie University. Further appointments have been made with Dr. Jason Busse DC, PhDCCRF/CIHR Chiropractic Research Chair, Assistant Professor Department of Clinical Epidemiology & Biostatistics Faculty of Health Sciences Institute for Work & Health McMaster University and with Dr. John Srbely DC, PhD CCRF Professorship in Spine Mechanics and Human Neurophysiology, Assistant Professor College of Biological Sciences, Department of Human Health and Nutritional Sciences University of Guelph [31].
There are three other Chair or Professorship posts to be filled by July 2010 [30].
1. Dr. xxxxx DC, PhD, CCRF Professorship in Spine Biomechanics and Neurophysiology, Assistant Professor, School of Medical Rehabilitation, Faculty of Medicine, University of Manitoba
2. Dr. xxxxx DC, PhD, CCRF Professorship in Rehabilitation Epidemiology, Assistant Professor Faculty of Medicine, McGill University
3. Dr. xxxxx DC, PhD, CCRF Research Chair in Neuromusculoskeletal Health, Assistant ProfessorFaculty of Kinesiology and Health Studies, University of Regina.
10. Future Post Funded at McGill
Under the Heading “Hot Topics” the McGill University Faculty of Medicine Electronic Newsletter carried the following details as recently as April 16th, 2010:
McGill University will create a CCRF Professorship in Rehabilitation Epidemiology following a $500,000 gift from the Canadian Chiropractic Research Foundation. The position will be within McGill’s Faculty of Medicine, along with the Department of Epidemiology, Biostatistics and Occupational Health. [32]
11. Hospital and public health integration
A project exploring the integration of Chiropractic Health Care into a Primary Care, Hospital-Based Setting was conducted by Dr. Deborah Kopansky-Giles.at St. Michael’s Hospital via a $600,000 grant from the Ontario Ministry of Health and Long Term Care. The two-year project tested health service delivery in a teaching hospital where chiropractors were integrated as staff practitioners. [32] The project was assumed a success and as of June 2007, Dr. Kopansky-Giles and Dr. Igor Steinman, DC, FCCS(C) have both been given permanent funding and have been incorporate into the primary care staff at the hospital.
4.6.3 AUSTRALASIA
a) The Australian Spinal Research Foundation (ASRF)
The Australian Spinal Research Foundation was founded more than thirty years ago by members of the Australian Chiropractors Association who desired for chiropractic to play a bigger role in Australian health care. The members understood that the profession itself needed to become a leader in funding its own research and research was needed to help grow the profession.
The ASRF is focused entirely upon chiropractic research with recognition of the importantce of the analysis of and adjustment of vertebral subluxations.
Since 2000 the Foundation has sharpened its’ focus on investment in chiropractic research. This required some reworking of the application process for grants with the Foundation ultimately adopting a “Research Culture Statement” in 2007 to guide all grant-making decisions. [34]
Research Priorities
In 2010 the ASRF had two research priorities namely Fundamental research and clinical research.
i. Fundamental Research is concerned with expanding the knowledge and understanding of the subluxation.
ii. Clinical Research of interest to the ASRF were studies of the changes made by chiropractic adjustments on the spine, nervous system, global health and quality of life [34].’
Communications
To the ASRF communication is part of its Mission. They use a typical array of media such as newsletters, bulletins and fact, email to share knowledge. The ASRF also has a Student Liaison Group (SLG) to connect the Foundation with the students. An SLG is found on chiropractic campuses with volunteer student representatives. This allows ASRF to communicate and also get feedback from the student body. [34]
The Future
The ASRF see themselves as an organization that is nurturing chiropractic so they look forward enthusiastically to the future. [34]
Research Committee
The Research Committee is the body that recommends to the ASRF governors those projects that should receive funding. The committee can also provide a supporting role to the grant recipient to assist in the research through advice or through contacts. [34]
Specific Roles and Responsibilities
The roles of the Research Committee are [34]:
- Review initial grant applications
- Send applications on to the Clinical Advisory Panel (CAP) for their opinion and decision.
- Present to the Board applications that are deemed of quality and invite full grant submissions by the applicants.
- Review the full grant submissions and send for external peer review. Peer- reviewers are chosen based on expertise in topic area following a meeting of the committee.
- Study other research matters when they arise.
- Put forward the financial plan to cover the cost of research taking into account new grant applications as well as on-going research.
Profiles of Research Committee Members
The background of the Research committee and their contribution to research projects and scientific endeavor over a considerable period of time is worthy of note. Among the members of the Committee are Dr. Ray Hayek BSc (Hons), MChiro, PhD, FICC, FACC (Chairman), Prof Elizabeth Deane, BSc (Hons), PhD (Deputy Chairman), Associate Professor Barbara Polus BAppSc (Chiro), MSc, PhD, Professor Charles Oxnard BSc (Hons), MBChB, PhD, DSc (Science & Engineering)
b) New Zealand
i. The New Zealand Chiropractors’ Association
On the website of the New Zealand Chiropractors’ Association there is a section providing information on ’Research and Literature’. The reasons for the material presented and a well-selected number of research reports are listed under various groupings or categories. [35]
Evidence exists that provides support for much of the basic tenets of chiropractic. The evidence is from chiropractic as well as non-chiropractic research. As always research is an on-going process of exploration and review.
Surprisingly chiropractic and spinal manipulation are actually well studied treatments. Whilst recognizing study strengths and limitations, most studies show support for chiropractic.
Pertinent scientific papers and articles are presented below under the following headings with the added advice:
Among the topics covered on the NZCA website are:
- Pain syndromes of the Back and Neck, Headaches and Other Neuro-musculo-skeletal conditions.
- Government studies and studies of outcomes, effectiveness and cost.
- Review of education for Chiropractors and medical professionals.
- Issues related to treatment Safety and risks.
- Sports chiropractic.
- Better health and lifestyle
We take as an example the material presented under the second category listed by the NZCA [35]:
Government studies and studies of outcomes, effectiveness and costChiropractic treatment often shows very good patient satisfaction ratings as well good cost effectiveness in overnment and insurance studies. Increased usage of chiropractic and greater incorporation into existing health care services is suggested from these studies.
Some published articles in this realm include those below:
- Gemmell HA, Hayes BM. Patient satisfaction with chiropractic physicians in an independent physicians’ association. Journal of Manipulative and Physiological Therapeutics ; 2001 (Nov-Dec); 24 (9): 556-559
- Giles, L, Muller, R. (2003) Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine , 28(14):1490-1502
- Haas M, Sharma R, Stano M. (2005) Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain. Journal of Manipulative and Physiological Therapeutics , 28 (8): 555√563.
- Inglis BD, Fraser B, Penfold BR. (1979) Chiropractic in New Zealand, Report of a Commission of Inquiry. Wellington, New Zealand: Government Printer.
- Jarvis KB; Phillips RB; Morris EK. (1991) Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, 33(8):847-52.
- Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. (2003) Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 326(7395):911
- Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. (2004) Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs. Archives of Internal Medicine , 164 (18): 1985√1892.
- Manga P (2000). Economic case for the integration of chiropractic services into the health care system. Journal of Manipulative and Physiological Therapeutics ; 23(2): 188-122.
- Meade TW, Dyer S, Browne W, Townsend J, Frank AO. (1990) Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal ; 300 (6737): 1431-1437
- Meade TW, Dyer S, Browne W, Frank AO. (1995) Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. British Medical Journal ; 311 (7001): 349-351
- Nwuga, V.C.B. (1982) Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. American Journal of Physical Medicine , 61, pp. 273-278.
ii. The New Zealand College of Chiropractic
As with all chiropractic educational institutions around the world the New Zealand College is involved with various levels of research and it looks to develop into a major contributor to the knowledge base on chiropractic science. Under the heading of Research on the College website we find [33] that developing an international center of excellence is the vision of the research department. The centre undertakes research in neurophysiology fields such as studying the effects of adjustment on the autonomic nerves and assessing falls risk. The centre is producing good quality research as evidenced by researcher Dr Heidi Haavik winning the Research Poster award at the 2011 WFC conference held in Brazil. [36]
c) England
i. House of Lords
Extensive investigation by the House of Lords Select Committee on Science and Technology of Complementary and Alternative Medicine led to specific recommendations being made in their report with regard to Research. [21 November 2000] Among those recommendations in the House of Lords Science and Technology – Sixth Report [37] (http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm) Summary of Recommendations we find:
33. To achieve equity with more conventional proposals, we recommend that research funding agencies should build up a database of appropriately trained individuals who understand CAM practice. The research funding agencies could then use these individuals as members of selection panels and committees or as external referees as appropriate (para 7.45).
34. We recommend that universities and other higher education institutions provide the basis for a more robust research infrastructure in which CAM and conventional research and practice can take place side-by-side and can benefit from interaction and greater mutual understanding. We recommend that a small number of such centres of excellence, in or linked to medical schools, be established with the support of research funding agencies including the Research Councils, the Department of Health, Higher Education Funding Councils and the charitable sector (para 7.57).
35. Bodies such as the Departments of Health, the Research Councils and the Welcome Trust should help to promote a research culture in CAM by ensuring that the CAM world is aware of the opportunities they offer. The Department of Health should exercise a coordinating role. Limited funds should be specifically aimed at training CAM practitioners in research methods. As many CAM practitioners work in the private sector and cannot afford to train in research, we recommend that a number of university-based academic posts, offering time for research and teaching.
37. We recommend that the NHS R&D directorate and the MRC should pump-prime this area with dedicated research funding in order to create a few centres of excellence for conducting CAM research, integrated with research into conventional healthcare. This will also help to promote research leadership and an evaluative research culture in CAM. Such funds should support research training fellowships and a limited number of high-quality research projects. This initiative should be sufficient to attract high-quality researchers and to enable them both to carry out large-scale studies and to continue to train CAM researchers in this area within an environment. We believe ten years would be sufficient for the pump-priming initiative as, for example, in the case of some MRC programme grants and various training and career development awards available in conventional medicine. The Association of Medical Research Charities may also like to follow this example (para 7.102).
ii. Government Response
By March of 2001 The Department of Health presented to Parliament the “Government Response to the House of Lords Select Committee on Science and Technology’s Report on Complementary and Alternative Medicine”. [38] It is interesting to note the apparent support the Government or the Ministry of Health had given to the recommendations made in the area of research.
The Introduction to the Government Response opens with this statement; –
’This Report publishes the results of the first ever comprehensive Inquiry into Complementary and Alternative Medicine (CAM) in the UK by a Parliamentary Select Committee.’[38]
After enunciating some very clear principles, not the least of which is; ’If taken seriously by both the orthodox and complementary medicine, the Report could also bring significant benefits to medicine as a whole‘, the Introduction concludes with the statement ’This document reproduces each of the Report’s recommendations in turn, and provides the Government’s response to them.’
Hereunder is the Governments response to each of the major recommendations relating to research: [38]
The Response to 33: –
The Government has recognised the need to involve appropriate experts on relevant panels and committees or through the peer review process. For example in commissioning projects covering CAM the Health Technology Assessment programme invited comments from appropriate peer reviewers through the Research Council for Complementary Medicine.
The Medical Research Council (MRC) will be developing databases of research experts who are familiar with the issues raised by CAM research. At present the pool of CAM practitioners who are expert in research is limited; and many of these experts will be people whose primary experience is in non-CAM medical research.
The Response to 34 and 37: –
Recommendations 34 and 37 seem to address the same issue.
The current capacity for research in this field and the scale of current research make it premature to talk of setting up separate centres of excellence. Research capacity cannot be created simply by forming academic posts – clinical trials, as in conventional medicine, depend also on commitment, attitudes and competence of practitioners in the field.
We recognise the need to develop the research capacity in this field. It is important that high quality researchers are developed and the Department is considering the best way to achieve this objective. We will be asking the NHS R&D Workforce Capacity Implementation Group to consider research capacity development needs in CAM and how these might be met. One of the options to be explored includes the provision of funding for Fellowships within the Department’s priority areas, with funding for pilot projects included.
Proposals for CAM research can be considered through the usual funding mechanisms of the Department of Health and the MRC, and some CAM research has been funded through existing schemes, in competition with other research. In the short term a ring-fenced scheme would be unlikely to succeed in adding substantially to the volume of research in this area, given the need to increase the research base in this field.
The Department welcomes proposals for CAM research in response to the stated priority areas it is currently taking forward. The NHS Cancer Plan identifies the need to review the evidence of complementary therapies in relation to supportive and palliative care and the Department will be seeking high quality proposals for work in this area.
However it is important that links should continue to be made between researchers already working in or interested in this area with a view to developing and strengthening research networks, which in turn will encourage the production of high quality research into CAM. [38]
iii. A Royal Opinion from HRH the Prince of Wales
It is interesting to note that in the period between (late 2000) the tabling of the House of Lords Select Committee on Science and Technology report on complementary and alternative medicine and the presentation of the Governments Response, the Prince of Wales had made pertinent comment in the British press regarding the need for research into Complementary and Alternative medicine. His article carried in the Times newspaper brought great protest from various quarters opposed to the funding of clinical trials into the efficacy of alternative or complementary medicine. His Royal Highness had observed [39]:
Conventional medicine receives most of its research funding from prominent organisations and from pharmaceutical groups. He noted that prominent organisations were reluctant to put money into complementary medicine for fear their reputation may be affected. Additionally he noted that many non-conventional therapies did not use medication and those that did, such as herbal and homeopathic had only small companies producing products. These small companies did not have the financial capacity to support large research projects.
He then sought to address funding matters, taking note that in the USA, the government backed National Center for Complementary and Alternative Medicine (NCCAM) had a budget of $68 million (dollars) which was expected to increase to $78 million in 2001. The NCCAM was active in 11 research centres and also worked with other bodies such as the US National Cancer Institutes.
However in the UK, research at the University of Exeter found that for every £100 of NHS medical research funds less than 8pwas put towards complementary medicine. Even more revealing is that the Medical Research Council in 1998-99 funded nothing whatsoever and UK medical charities in 1999 only put 0.05% of their total research budget into complementary medicine. Of note, The Arthritis Research Campaign has provided funding, for a two year trial of acupuncture for knee osteoarthritis.
HRH The Prince of Wales then suggests that a national strategy for complementary and alternative medicine research is needed. Through appropriate funding the Foundation for Integrated Medicine would be able to implement the strategy. The overall strategy broadly covering allocation of funding, networking opportunities, spreading information and monitor projects .However more serious funding would be needed to establish bursaries, fellowships and research centres.
He opines that clinical trials are not the only pre-requisites to use a healthcare therapy. Exploring via surveys WHY people use complementary medicine and the benefits they receive through belief and trust should be done. Finally he notes that complementary medicine can be a powerful resource that needs to be systematically studied and made more widely available to those with limited means. [40]
iv. Anglo-European Chiropractic College
The Anglo-European Chiropractic College is the oldest and largest chiropractic college in Europe. The College has been at the forefront of chiropractic education and research in Europe for over four decades and accordingly it has attracted students from all over the world. A number of its graduates have gone on to be involved with meaningful research upon returning to their countries of origin.
The College publishes a biennial Research Report that can be downloaded from its website [http://www.aecc.ac.uk]. With the 2005-2007 report the college began to incorporate reporting upon its own faculty projects with that of the staff of the Institute of Musculoskeletal Research and Clinical Implementation. (IMRCI) This facility, which is situated within the College, was established in 1999. It has as its focus collaborative, multidisciplinary research that sustains a chiropractic presence in health care research.
College research on the other hand, has a more diverse agenda in experimental, clinical and educational research. There is a strong emphasis through research on staff development and scholarship, which is essential in underpinning the teaching-research interface, and ensuring that the taught curricula at AECC are evidence-based.
In the introduction to the 2007-2009 Report Professor Jenni Bolton, as Director of Research and Graduate Studies and Professor Alan Breen, as the Director of IMRCI make the following observation [40] that the college has an exciting research strategy with the Doctorate Research Fellowship programme expected to expand. The college will actively support staff research efforts as well as seek to attract new talent to lead research in new areas. Multidisciplinary collaboration with other professions is making progress and remains a key focus area.
In the chapter entitled ’Research Grants, Awards and Memberships‘ we find the listing of Research and Graduate Studies Academic Years September 2007 to August 2009 and then a breakdown or listing of the total awards in 2007 to 2008 and then for 2008 to 2009. It seems clear that during the years accounted for no funds have been provided through Government sources for research projects conducted at the Anglo-European Chiropractic College. [40]
Research Grants [40]
2007-2008
AECC Enterprises Ltd (IMRCI). Objective Spinal Motion Imaging Assessment (OSMIA). OthoKinematics
– £65,773.73
Bagust J. A comparison of changes in heart rate variability induced by manipulation of the thoracic and lumbar spine in patients attending a chiropractic clinic.
The Gerald Kerkut Charitable Trust
– £6,750
Bolton JE. Grant for Research Fellow (Bruno P). College of Chiropractors
– £3,750
Bolton JE. Grant for Research Fellow (Davies L). British Chiropractic Association
– £20,000
Foreman RC, Brown ID and Bagust J. A comparison of physiological and biochemical indices used in the evaluation of the stress response in human subjects. Assessment of their potential in evaluating the effectiveness of chiropractic adjustment on patient wellbeing.
The Gerald Kerkut Charitable Trust
– £4,925
Gemmell H. Comparison of the efficacy and safety of cervical mobilisation, manipulation and activator in patients with sub-acute neck pain: a randomised trial.
– ECU €5,000
IMRCI. Learning to improve the management of back pain in the community (LIMBIC). Health Foundation
– £14,750
Wilson FJH. Doctoral research grant: Professionalisation of chiropractic in Britain, 1908-2001 European Chiropractors’ Union
– £10,000
2008-2009
AECC Enterprises Ltd (IMRCI). Objective Spinal Motion Imaging Assessment (OSMIA). OthoKinematics
– £30,000
Bolton JE. Grant for Research Fellow (Davies L). British Chiropractic Association
– £20,000
Bolton JE. Grant for Research Fellow (Houweling T). British Chiropractic Association
– £20,000
Foreman RC, Brown ID and Bagust J. A comparison of physiological and biochemical indices used in the evaluation of the stress response in human subjects. Assessment of their potential in evaluating the effectiveness of chiropractic adjustment on patient wellbeing.
The Gerald Kerkut Charitable Trust
– £4,925
IMRCI. Learning to improve the management of back pain in the community (LIMBIC).
Health Foundation
– £18,500
Miller J. Colic RCT. British Columbia Chiropractic Association
– £4500
v. The Welsh Institute of Chiropractic at Glamorgan University
On November 23rd, 2007 The University of Glamorgan announced the launch of the University Research Investment Scheme. The University Research Investment Scheme (URIS) supports research within the University of Glamorgan across its’ five Higher Education Faculties, which includes Health, Sport and Science wherein the Institute of Chiropractic is situated. [41]
Within the Faculty of Chiropractic in August 2009 Mark Langweiler and Peter McCarthy were awarded a URIS grant of £9960. The study they are involved with is a collaborative effort with a team from the Faculty of Advanced Technology and with Dr Colin Gibson of Rookwood Hospital. The study will develop a modeling system for design seats for wheelchair users.
In late 2008, Annabel Kier & Peter McCarthy received aa grant of £4,980 from the Chiropractic Patients Association for continued research into managing back pain. Their study involves the benefits of addressing yellow flag indicators by having patients related their pain experience.
Comment
“In that the Welsh Institute of Chiropractic at Glamorgan University has sparse reference to research grants it seems clear that the recommendations of the House of Lords Select Committee and those from the Ministry of Health regarding research in areas relating to chiropractic are being completely ignored in the United Kingdom”.
e) Europe
Some of the earliest, most meaningful research into chiropractic techniques and procedures were conducted in Europe. The most prominent researcher is arguably Dr Henri Gillet from Belgium
Gillett was a prolific writer and lecturer on spinal joint motion palpation as a method of identifying spinal fixations. This work was extended by Dr L. John Faye of the Motion Palpation Institute. [42]
Marcel Gillet (Dr Henri’s brother) initiated research on the concept of the subluxation concept itself. He concluded that stiffness, movement limitation or fixation was the key. This was deemed revolutionary at the time and was in conflict with the concept of misalignment as taught in the USA. Another prominent figure was Dr. Fred Illi of Switzerland. [43]
At this time (2010) ’the European Chiropractors’ Union (ECU) [which] is established to promote the development of Chiropractic in Europe as well as to pursue the interests of Chiropractic as a science and a profession by research, teaching, publications and legal activities (and which) … represents the Chiropractic profession in Europe on a supranational level (provides funding for appropriate research in both England and on the continent). [44]
It can be seen that the ECU continues to support meaningful research into chiropractic care at the AECC. See para d) iv above.
Recent and ongoing research throughout Europe could not exist were it not for support from the chiropractic profession. A research programme reported upon as recently as December 2009 serves as a clear example.
This study by Leboeuf-Yde et al [45] sought to study the impact of low back pain patients’ psychological profile on their treatment outcome. The study was supported by grants from Landstinget, Östergötland, FoUU-gruppen, Swedish Chiropractors’ Association (LegitimeradeKiropraktorersLandsorganisation) as well as some of the authors being on research grants or salaried research positions. The full article is found here:
The Nordic Subpopulation Research Programme: prediction of treatment outcome in patients with low back pain treated by chiropractors – does the psychological profile matter? By Charlotte Leboeuf-Yde, Annika Rosenbaum, Iben Axén, Peter W Lövgren, Kristian Jørgensen, Laszlo Halasz, Andreas Eklund and NielsWedderkopp
Chiropractic & Osteopathy 2009, 17:14doi:10.1186/1746-1340-17-14
The electronic version of this article is complete and can be found online at: http://www.chiroandosteo.com/content/17/1/14 [45]
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