A Chiropractic Research Agenda

There has been quite of bit of talk lately about the project entitled, "A National Workshop to Set the Chiropractic Research Agenda." Not all of it has been accurate, and so I am using this opportunity to explain some of the background, the process, and what I hope will be the ultimate outcome. The purpose of the project is to conduct a meeting to arrive at a consensus of experts about chiropractic research topics and their priorities. Five general areas for chiropractic research will be explored. They are: outcomes research, clinical research, educational research, health services research, and educational research. The results of the deliberations will be published in the refereed scientific literature where they can be easily retrieved and used.

The Research Agenda Workshop is funded by the Bureau of Health Professions of the U.S. Health Resources and Services Administration (HRSA). This is the same Federal agency that funded three chiropractic clinical demonstration projects that are now underway at Western States Chiropractic College, Los Angeles College of Chiropractic, and National College of Chiropractic. The Research Agenda Workshop project is fundamentally different from those efforts in at least two ways. First, the demonstration projects are clinical outcome research studies that involve collection of data on patients or subjects; the Research Agenda Workshop is a one-time event. Secondly, the demonstration projects are funded grants, while the Research Agenda Workshop is a funded contract. (HRSA has funded several other contracts with Palmer College of Chiropractic on interdisciplinary training.)

From the Federal government's point of view, a grant is a different kind of animal than a contract. Essentially, the way in which a grant project is designed, in terms of specific objectives and processes, is almost entirely in the hands of a Principal Investigator (the person in charge of doing the study at the institution). In a contract, the government agency specifies the goals and how a project is to be conducted in advance, and then asks if anyone wants to do it that way. Whoever can do the best job for the best price then wins the contract.

The Research Agenda Workshop contract specified the size and professional makeup of the group to be assembled, the way in which the Workshop is to be conducted, and what the final product will be. The result has led to the creation of a multidisciplinary group with very strong expertise in the five topic areas to be addressed. The group includes not only chiropractors, but basic scientists, professional educators, medical and osteopathic physicians, and allied health professionals (a physical therapist and an occupational therapist). In addition, at least three high-level government officials from the National Institutes of Health (NIH), the Agency for Health Care Policy and Research (AHCPR), and HRSA, will be present.

Some may grumble that there ought to be more chiropractors; or that we should not have individuals who are not directly linked to chiropractic, but that is a short-sighted complaint in my opinion. The hope for such an event as this, is to actually jump start research in all the areas described above. The famous 1975 NINCDS conference on the "Research Status of Spinal Manipulative Therapy," was the genesis for much of the research that has occurred in the past 20 years. Without a multidisciplinary approach to the issues of the time, it is doubtful that much of that important work would have been accomplished; and that we would not now be enjoying the imprimatur of prestigious government agencies like AHCPR and its guidelines on back pain.

Similarly, this Research Agenda Workshop includes chiropractors with a professional stake in chiropractic research per se, established scientists who have the resources and organizations to actually conduct research, and research funders and administrators. An anticipated outcome of the Workshop is to get everyone on the same scientific page such that real research work gets accomplished in an efficient way. I have no doubt at all that the Workshop participants, regardless of professional background, will be persuaded of the need to invest time, money and effort in chiropractic research.

In preparation for the Workshop, five exhaustive reviews of the scientific literature are being prepared, one on each of the research topics discussed above. These documents will identify the major and minor gaps in the chiropractic knowledge base and explicitly provide the basis for designing new studies. Each participant will be required to read these lengthy documents before the meeting.

In addition, three separate surveys are being conducted to provide more information to the participants. One survey, now underway, is being sent to 2000 randomly selected practicing chiropractors. It requests their opinions about chiropractic research topics and priorities. Another survey is being completed by every chiropractic college faculty member in the United States. When complete, it will be the largest study of chiropractic college faculty attitudes, behavior and knowledge of chiropractic research ever accomplished. Finally, the research administrators at all CCE accredited chiropractic colleges are responding to a survey with respect to the resources they need to build a chiropractic research infrastructure. All together, this information will provide a powerful argument for the funding and doing of chiropractic research.

Finally, it should be obvious that with the Federal government underwriting the cost, the results of the Chiropractic Research Agenda Workshop cannot be ignored by government agencies. Politically, it doesn't make sense to fund a priority setting project, and then not use it when scientific policies are created at the Federal level. Although I still cannot say that chiropractic has arrived on the established scientific scene, I do believe we are clearly on the right road. Please support this effort.