Dr. David Leprich
Each chiropractic student can likely describe a different path which lead them to choose chiropractic as a career. For many, it was the influence of a family member who had built a successful practice. For others, it was their positive experience as chiropractic patients which provided the impetus. For me, it started with a grade 10 chemistry teacher. Mr. Tanner looked a bit like Einstein, with more hair. Rather than dive into a diatribe on Boyle’s law, he asked a question. “What would happen if you tried to boil an egg at the top of a mountain?” This was followed by anecdotal reports of egg boiling taking much longer than expected. In open discussion, we agreed that reduced air pressure at altitude might lower the boiling point of water and was a plausible explanation for this result. Mr. Tanner helped us design a few simple experiments which would prove or disprove the effect of pressure on boiling point. Years later, I realized that he had instilled in me a basic understanding of the scientific method. Unfortunately for me, and for most of the chiropractors I have discussed this issue with, the scientific method has taken a back seat to economics, politics and the realities of providing health care in Canada. A recent article reviewing the scientific method brought this crashing home to me.
For those who may have forgotten, the scientific method includes four steps:
observe and describe a phenomenon,
create an hypothesis to explain the phenomena,
use the hypothesis to make a prediction about the existence of other phenomena,
perform experiments to test the predictions.
Although performing experiments with patients in your clinic may be somewhat counterproductive, observing and asking questions of your patients are vital to providing appropriate care. Far too often, concerns about building a practice, anti-chiropractic headlines and the daily rigours of running a business dilute the impact of the scientific method within our clinics. We still treat people, they still get better and most of us continue to seek new ways to help our suffering patients. In many ways, however, practitioners have lost the sense of being at the leading edge. Fortunately, we have in the profession a few members who are highly skilled at asking those “boiling an egg on the mountain” questions. These chiropractors have dedicated their professional careers to asking the questions which will broaden the chiropractic horizon, and finding answers to those questions. The work they are doing will ultimately make practice life easier and busier for you and I. Since you have chosen to devote your energies to building and maintaining a practice, you likely do not have the time or expertise to advance chiropractic by doing your own research. You can still be involved by supporting the program that is moving the yardsticks. While space does not permit a detailed picture of the structure of chiropractic research in Canada, it is important for each of us as chiropractors to understand what is being done and how we can help.
The vast majority of health sciences research takes place within our universities. It won’t surprise you to learn that until recently, none of the university based research programs were knocking themselves out trying to expand the base of knowledge about chiropractic. A decade of hard work by a very small group of people has changed that. In the past, having chiropractors commit to doing research was difficult because there was no outside support. We now have chiropractors sitting as research chairs in a number of Canadian universities. The end result has been a tremendous increase in the body of knowledge about what we do. This information is viewed by others as an authoritative and independent endorsement of the profession. Each new chiropractic research chair initiates and promotes new projects. The outcome of each project moves the sticks another yard forward. As this effort gathers more momentum the small size of our workforce becomes apparent. There are a number of important projects currently under way and many more in the development stages. For example, Dr. Jill Hayden recently conducted a review undertaken as part of her research agenda. A synopsis of this review follows:
Exercise therapy for low back pain
Hayden et al
There is an overwhelming amount of information relevant to practicing chiropractors produced in journal articles and textbooks. Also, many practitioners are not prepared to tell which research information they can trust. Systematic review has become a common research method that aims to synthesize and make sense of discrepancies across large numbers of studies. We can use the results of systematic reviews to treat patients using the best evidence and have more informed communication with other healthcare providers, payers, and relevant stakeholders.
The research of Dr. Jill Hayden (DC, PhD, Centre of Research Expertise in Improved Disability Outcomes, University Health Network, Toronto) has included several systematic reviews. One review, conducted within the framework of the international Cochrane Collaboration, synthesized 61 randomized controlled studies that evaluated the benefits of exercise therapy for treating patients with low back pain.
“By combining the results of these studies, we are able to better understand the true effect of exercise,” says Hayden. “We found that adults with chronic low-back pain had modest improvements in physical function and pain with exercise therapy.”
Only a small number of studies examined subacute low-back pain. There was some evidence suggesting workers with subacute LBP benefited from a program that included a gradual increase in the intensity (type and amount) of exercise.
A further focused review identified particular characteristics of exercise interventions that contributed to decreased pain and improved function. This novel analysis found that the most effective strategy seems to be supervised, individually tailored exercise programs. Stretching and strengthening exercises were the most effective in improving pain and function in adults with chronic low-back pain.
While chiropractors have long known that exercise and physical activity are more beneficial for back pain patients than bed rest, the information resulting from this review accomplishes two goals. It provides specific parameters about which type of activity is more beneficial. This allows us to be more effective when treating certain patients. It also distinguishes chiropractic as a leader in the important area of low back rehabilitation.
While it may not be possible for you to become directly involved in research, you can assist those who are. The co-ordination of research activity is currently undertaken by the CCRF. Funding for this body currently comes in part from us; chiropractors who are willing to spend a few dollars. Those of us who have a bigger vision for our profession gladly pay $125.00 annually to support the CCRF as members. Included with this issue of the JCCA is a brochure which further describes the CCRF program and a membership application form. Please take a moment to review that material. Then, complete the application and send it in.
I realize that many demands are made of your clinic income. To help you make a positive decision today, all I ask is that you consider what would happen if every chiropractor in Canada made this small contribution to the CCRF. Imagine “chiropractic research” being conducted at all of our leading universities. Imagine the impact on our practices and the lives of our patients as new research provides evidence for applications of chiropractic care that we haven’t yet considered. All we have to do as a profession is ask the right questions and uncover the answers. All we have to do as practitioners is give our researchers the power to do the job.