March 2006 
 Is there a gap between chiropractic research and clinical worlds?

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Dear Colleague:

The theme of this year's ACC/RAC Conferences (Association of Chiropractic Colleges / Research Agenda Conference) was multidisciplinary collaboration and integrative treatment. Some of the goals involved sharing how chiropractors are working in integrative arenas such as in hospital settings, military health centers, and developing new and innovative possible collaborative models. Ultimately the question is, "What is in the best interest of the patient?"

Part of developing a collaborative model in the medical field is concurrently developing a reasonable evidenced based approach to chiropractic care being rendered. While there is a minority of chiropractors who both maintain a full time practice and are active with research, the majority of those in the chiropractic community tend to lean towards research or clinical practice. As is prevalent in all forms of health care there can be two completely different agendas promoted by each "camp." It is my belief that a way for chiropractic to develop a functional evidence base and become "healthy" is that we need to find a way to bridge the common misperceptions each faction has of one another.

With due respect I hope you find the following few short commentaries not inflammatory but an attempt to reach out and move agendas, which we might have in common, forward.

 Proprietary techniques, technique wizards, and technique peddlers
 A rose by any other name still smells

One way for chiropractic to mature and grow as a profession is to challenge ourselves to go beyond an easy way out or focus on an exclusionary mindset. All the professions seem to have an emotional dysfunctional relationship between its clinicians and researchers to some degree. There are extremes on both sides but regretfully focusing on the extremes of either side is not a way of bringing the majority of clear thinking doctors together.

As a clinician attempting to become involved in the chiropractic research community I hear a common cynical "tongue in cheek" description of clinicians practicing or teaching a chiropractic technique. These comments tend to focus on describing chiropractic teachnique instructors as, "technique wizards, gurus, technique peddlers." If this is meant as a warm and fuzzy expression, let me tell you from a proponent of SOT that I find it extremely offensive and hurtful. Are there a percentage of unscrupulous technique practitioners? Of course there are. But, in my experience the majority are populated by doctors who have had success helping patients in their clinics and want to share their knowledge. Do they need to understand the research literature and be cautioned about over statements? Again, of course they do.

But for our chiropractic community to grow the clinicians need to understand that our research community is here to help us better understand the phenomenon we are finding in our practices, and likewise the researchers need to be open to what the doctors in the field are experiencing in their clinics.

Fear of loss, be in money, security or power, regretfully tends to drive our human condition. Striving to be conscious of this frailty is a never ending process. Researchers want funding and money for their budget and compensated for their efforts, chiropractic clinicians want to be compensated for the services they render their patients, and chiropractors teaching chiropractic techniques want to be compensated for their time, travel and efforts also. In all arenas it is important to focus on supporting those that are ethical and reasonable. To place one group in one place, without differentiating those who are scrupulous with those who are not, does not move us forward as a profession or society.

 


 Chiropractic Research Peddler Technique
 A clinicians perspective of where research is taking our clinical techniques

Since RAC/ACC 2005 I have had something smoldering inside my brain. That is something I am considering calling the chiropractic research peddler technique. This technique is called CMT/SMT and routinely assumed to be diversified methods of care. It might commonly include muscle work possibly called ART also, but the reason why is not explained, it just does.

It acknowledges that it has virtually no valid or reliable indicator for its use, nor any clear way of either determining which vertebra to adjust or if they are even contacting or applying a specific force to a region of the spine. According to some proponents, as they wink and nod to each other, it doesn't even matter. It doesn't use radiographs, motion palpation, leg checks or anything other than maybe pain, but is not clear how to discern its location of contact, direction of contact, or if the treatment rendered was appropriate. A specific contact or directed force is not really important since all that is needed is a general mobilization almost in any direction to either side of the spine.

This paradigm is the accepted technique in chiropractic research circles and circumspectly condemns other chiropractic techniques as being unscientific, developed by technique gurus and peddlers hustling the chiropractic practitioners for money.

From my perspective I do not feel that there is sufficient research completed that our techniques can be judged too harshly yet. It does take time to do research and as witnessed in the chiropractic research community those publishing research is relatively small. It seems reasonable to assume that there would be even less practitioners in the clinical community who would have a leaning towards research. This means that our clinicians and technique communities need to learn how to develop an ethical and research mentality.

 


 SOT Entering the 21st Century
 Developing an Evidenced Base Approach

The relationship between research findings and actual practice in the clinical environment is something that has led to conflict in all fields of healthcare. Chiropractic is no different and often times there have been schisms between its research and clinical worlds. Ultimately research should be about helping the clinician develop the best, most effective, low risk, and high benefit diagnosis and treatment. This article discusses some possible beginning steps towards helping SOT move forward into the evidenced based arena.

SOT Entering the 21st Century 


 Researching "brand name" techniques
 Gary Knutson, DC - Monday, August 29, 2005

Gary Knutson, DC, in his blog discusses an issue about research and "brand name" techniques. He approaches the relationship between our techniques and research from another perspective. Dr. Knutson states:

"It's time for the chiropractic intelligentsia to stop ignoring brand name techniques, hoping they will go away. It's time for the chiropractic intelligentsia to approach "brand name" techniques in the name of scientific inquiry. And it's time for brand name techniques to step-up to be tested."

Researching "brand name" techniques 


 Cervical Spine Adjusting and the Vertebral Artery
 Contemporary perspectives on patient safety and protection, clinical reality and patient management

Please see the following link which you might find helpful. It is a PowerPoint program on cervical manipulation and cerebrovascular events, how to predict them, and what you as a doctor can and should do. This PowerPoint program was produced by Dr. Gerald Clum, President of Life West Chiropractic College.

Contemporary perspectives on patient safety and protection, clinical reality and patient management 


 International Research Conferences - Abstract Deadline Schedule
 See left side for direct conference links

European Chiropractic Union Annual Convention - May 25-27, 2006 - Stockholm, Sweden: Abstract Deadline February 15, 2006 (past due date)

The Conference on Chiropractic Research - September 15-16, 2006 - Chicago, IL: Abstract Deadline March 31, 2006

WFC/ACC Conference on Identity - October 26-28, 2006 - Cancun, Mexico: Abstract Deadline June 30, 2006

International Research and Philosophy Symposium - November 3-5, 2006 - Spartanburg, SC: Abstract Deadline April 28, 2006

ACC/RAC Conferences - March 15-17, 2007 - To be Announced: Abstract/Paper Deadline August 21, 2006 (author signatures) - August 25, 2006 (paper submission)

WFC/FCER International Conference on Chiropractic Research (formerly ICSM) - May 17-19, 2007 - Vilamoura, Portugal: Abstract Deadline December 31, 2006

6th Interdisciplinary World Congress on Low Back & Pelvic Pain - November 7-10, 2007 - Barcelona, Spain: Abstract Deadline To be Announced

 


The goal of this communication is to help bring our profession together in a way that might foster greater communication and trust. Practitioners who have their patient's best interest at heart need guidance and direction from the research community who sees them as partners in healthcare delivery. Likewise our chiropractic research needs to take some direction from what is taking place in the clinical trenches. Both sides play an essential part in any growth or survival of chiropractic into the 21st Century.

Thank you for your dedication and interest

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Charles Blum
Sacro Occipital Technique Organization - USA

phone: 310-392-9795