News / Profession

What Does the Consortium for Chiropractic Research Do, Anyway?

Editorial Staff

The Consortium for Chiropractic Research (CCR) is comprised of researchers from almost every chiropractic college in North America, including a number of non-college members who support their efforts, the largest contributer being the California Chiropractic Foundation. The CCR is considered a "who's who" of the chiropractic research community.

But what do they accomplish? Is any of this research applicable to the practice of chiropractic, or does it hover in the stratified air of esoteric, abstruse scientific investigation with little down-to-earth value?

Any organization can best be judged by its accomplishments. The CCR currently has a number of research projects that are funded and currently in progress as well as many studies that have already been completed and published.

Below are just a few of the current projects: Judge for yourself if they are worth the effort.

The first of these projects, Outcomes Measurement Assessment: A Multi-site Comparative Analysis, involving eight chiropractic colleges, seeks to evaluate the usefulness and responsiveness of a variety of outcomes assessment instruments in the chiropractic clinic setting. Both general health assessment instruments and low back specific instruments are included. Results of this study will provide important information to chiropractic researchers selecting such instruments for clinical studies. Data will be polled from all participating colleges at Northwestern College of Chiropractic.

The principal chiropractic co-investigators in this study:

Howard Vernon, D.C.
Canadian Memorial College of Chiropractic

Ted Marcus, Ph.D.
Cleveland College of Chiropractic, Los Angeles

Kevin McNamee, D.C.
Los Angeles College of Chiropractic

William S. Jose, Ph.D.
Craig Nelson, D.C.
Northwestern College of Chiropractic

Elana Ferguson, M.S.
Palmer College of Chiropractic, Davenport

William C. Meeker, D.C.
Palmer College of Chiropractic, West

Mitch Haas, D.C.
Western States Chiropractic College

The second study, Three Site Outcomes Assessment and Data Pooling Demonstration Project: Focus on Low Back Pain, is a project involving three chiropractic colleges conducting a clinical series on low back pain. This study will assess the feasibility of conducting multi-site longitudinal research employing outcomes assessment instruments. Using both a general health assessment and a low back instrument, this project will track changes in outcomes among low back patients under chiropractic care. Results of this study will provide useful information for the conduct of future multi-site clinical trials. Data from participating colleges will be polled at Northwestern College of Chiropractic. Principal investigators for this project are:

William S. Jose, Ph.D.
Northwestern College of Chiropractic

Alan H. Adams, D.C.
Los Angeles College of Chiropractic

William C. Meeker, D.C.
Palmer College of Chiropractic - West

The third study is Low Back Pain Patient Outcomes Measurement Assessment. Functional health status assessment has become an increasingly important priority in clinical research. In a collaborative effort, Western States Chiropractic College and Cleveland College of Chiropractic, Los Angeles are evaluating the utility of the Dallas Pain Questionnaire and Oswestry Disability Questionnaire in college outpatient clinics. This study will attempt to answer the questions: Can the routine administration of these instruments be integrated into the regular operation of the clinics? What is the responsiveness of these questionnaires over a long period of time and what is the optimal frequency of administration? To address such issues, the questionnaires will be administered on a regular basis in the outpatient facilities to low back pain patients for the duration of care (up to six months).

Outcome assessment is clearly the by-word of the '90s and beyond. These and other studies will be the difference when chiropractic care is compared by governments and third party payers to other forms of health care. Outcome studies are making headway for the profession now, and could quite possibly be the difference between inclusion and exclusion in national health care.

The CCR not only wants to study what makes chiropractic effective, but also desires to define the attitudes held by those in the profession. One such study, A National Survey of Chiropractors' Attitudes with Respect to Standards of Care was recently completed.

Little is known about the attitudes and opinions of the 40,000 plus chiropractors in the United States with regard to practice standards. In as much as unusual opinions often command disproportionate attention, planning for the development of practice standards and their successful implementation requires an assessment of the relevant practitioner attitudes including the perceived credibility of the organizations and mechanisms which may be involved in standards development.

An inventory of standards' issues was determined by means of group interviews (focus groups) in three American cities, then quantified among practitioners by means of a 61-item mail questionnaire. 1015 questionnaires (42%) were returned from a two wave send-out sample of 2397 chiropractors stratified by state populations. Nationally projected (+/- 3%) proportions of age; gender; practice location; college attended; year graduated; GPA; additional degrees; position in practice; hours worked; number of patient visits in previous week; proportions of payment types; and membership in chiropractic professional organizations comprised the first 14 items of the questionnaire. The next 47 questions asked for level of agreement or disagreement to statements about validation, standards of care, respect for and visibility of leaders and organizations in chiropractic.

Although validation of chiropractic methods was often not associated with practice standards at all, attitudes of practitioners were generally more informed, more conservative, more scientific, and less clinically based than might have been expected from previous chiropractic literature. Chiropractic researchers were the most respected profession leaders and a consortium of chiropractic colleges was the type of organization favored to develop standards.

The CCR currently has two research studies that have been submitted to JMPT but not yet published:

Chiropractic Procedures and Technology Assessment Conferences: Structure and Process.
The Descriptive Profile of 141 Low Back Pain Patients of Field Practicing Chiropractors Contrasted with 395 Low Back Pain Patients Treated in the Clinics of Six West Coast Chiropractic Colleges.

Research studies that have been accepted by JMPT but are still in the process of publication are:

A Meta-Analysis of Clinical Trials of Spinal Manipulation.
Diagnostic Utility of the McGill Pain Questionnaire and Oswestry Disability Questionnaire for Classification of Low Back Pain Syndromes.
Effects of Upper vs. Lower Cervical Adjustments with Respect to the Amelioration of Lateral-Flexion vs. Rotational Passive End-Range Asymmetries.
Comparisons between Active vs. Passive End-Range Assessments in Subjects Exhibiting Cervical Range-of-Motion Asymmetries.
Leg Length Inequality: A Review.
Line Drawing Analyses of Static Cervical X-Ray Used in Chiropractic.
Lumbar Motion Palpation: A Literature Review.
Skin Temperature Assessment for Neuromusculoskeletal Abnormalities of the Spinal Column: A Review of the Literature.
Short Lever, Specific Contact, Articular, Chiropractic Technique: A Review of the Literature.
Manual Force, Mechanically Assisted, Articular Chiropractic Technique Using Long and/or Short Lever Contacts: A Review of the Literature.
Instrument Delivered Short Lever Chiropractic Adjusting: A Review of Principles and Practice.

Consortium studies that are currently in print:

A Comparison of Patients and Patient Complaints at Six Chiropractic College Teaching Clinics. JMPT 1989, 12(2):79. Joanne Nyiendo, Ph.D.; Reed Phillips, D.C. Ph.D.; William Meeker, D.C., M.P.H.; Gerald Konsler, Ph.D.; Robert Jansen, Ph.D.; Mohan Menon, Ph.D., et al.
A Comparison of Low Back Pain Profiles of Chiropractic Teaching Clinic Patients with Patients Attending Private Clinicians. JMPT 1990, 13(8):437. Joanne Nyiendo, Ph.D.
A Community-Based Study of the Use of Chiropractic Services. (In collaboration with the RAND Corporation.) Journal of the American Public Health Association 1991, 81(4):439. Paul Shekelle, M.D., M.P.H.; Robert H. Brook, M.D., ScD.
The Appropriateness of Spinal Manipulation for Low Back Pain: Project Overview and Literature Review. RAND Corporation Publication R-4025/1, 1991. Paul Shekelle, Ph.D., M.P.H.; Alan Adams, M.S., D.C.; Mark Chassin, M.D.; Eric Hurwitz, D.C., M.P.H.; Reed Phillips, D.C., Ph.D.; Robert Brook, M.D., Ph.D.
The Appropriateness of Spinal Manipulation for Low Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel. RAND Corporation Publication R-4025/2, 1991. Paul Shekelle, M.D., M.P.H.; Alan Adams, M.S., D.C.; Mark Chassin, M.D.; Eric Hurwitz, D.C., M.P.H.; Rolla Park, Ph.D.; Reed Phillips, D.C., Ph.D.; Robert Brook, M.D., Ph.D.

Conference Proceedings published by the CCR:

Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the First Annual Conference on Research and Education. June 28-29, 1991.
Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the Second Annual Conference on Research and Education. June 13- 14, 1987.
Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the Third Annual Conference on Research and Education. June 18-19, 1988.
Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the Fourth Annual Conference on Research and Education. July 1-2, 1989.
Transactions of the Consortium for Chiropractic Research. Proceedings of the Fifth Annual Conference on Research and Education. June 16-17, 1990.
Proceedings of the Sixth Annual Conference on Research and Education. Emphasis on Consensus. June 21-23, 1991, Monterey, California.
First Consensus Conference on the Validation of Chiropractic Methods. J Chiropractic Technique 1990 2(3).

Published Abstracts and Presentations by the Consortium:

Meeker, Phillips, Nyiendo, et al: A Study of the Prevalence and Characteristics of Low Back Complaints at Six Chiropractic Teaching Clinics. Proceedings of the 115th Annual Meeting of the American Public Health Association, October, 1987.
Nyiendo, Haas: A Descriptive Study of Non-Specific Low Back Complaints Presented by Patients Attending Six Chiropractic College Teaching Clinics. Proceedings of the 116th Annual Meeting of the American Public Health Association. November 1988.
Mootz, Meeker, Nyiendo, Phillips: A Study of the Prevalence of Low Back Pain Complaints in 60 Chiropractic Offices and Six Chiropractic Teaching Clinics. Proceedings of the 116th Annual Meeting of the American Public Health Association. November 1988.
Meeker: Back Pain Risk Prevention Programs: An Assessment Strategy. Proceedings of the Injured Worker Dilemma: Definitive Solutions. San Francisco Spine Institute. San Francisco, September 10, 1989.
Meeker: Is the Onset of Back Pain Predictable? A Test of Epidemiological Risk Assessment. Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the Fourth Annual Conference on Research and Education. Monterey, California, July 1, 1989.
Meeker: Quantifying Predictions of Low Back Pain Using Epidemiological Studies. Proceedings of the 1989 International Conference on Spinal Manipulation. Washington, D.C., March 31-April 1, 1989.
Phillips, Mootz, Nyiendo, et al., A Comparison of Patient Populations of Practicing Chiropractors and Chiropractic College Clinics at Six Metropolitan Centers. Proceedings of the 1989 International Conference on Spinal Manipulation. Washington, D.C., March 1989.
Shekelle, Brook: A Community-Based Study of the Use of Chiropractic Services. Transactions of the Pacific Consortium for Chiropractic Research. Proceedings of the Fourth Annual Conference on Research and Education, July 1-2, 1989.
Meeker: A Method of Back Pain Risk Assessment. National Safety Council Congress and Exposition. Las Vegas, Nevada, October 28, 1990.
Meeker, Karish, Jansen: Using HRA Concepts to Predict Morbidity of Low Back Pain. Proceedings of the 117th Annual Meeting of the American Public Health Association. New York, 1990.
Shekelle, Brook: A Community-Based Study of the Use of Chiropractic Services. American Federation for Clinical Research Annual Meeting. May 1990.
Shekelle, Brook: A Community-Based Study of the Use of Chiropractic Services. Proceedings of the 1990 International Conference on Spinal Manipulation. Washington, D.C., May 11-12, 1990.
Greenstein, Danielson, Hsieh, Phillips, Adams, Lueder: Can Changes in Stature Result from Sitting at Different Lumbar Support Depths? Proceedings of the 1990 International Conference on Spinal Manipulation. Washington, D.C., May 11-12, 1990.
Hansen, Jansen, Bartol, Hegetschweiler, Haas, Adams: Chiropractic Procedures and Technology Assessment Conferences. Proceedings of the 119th Annual Meeting of the American Public Health Association, Atlanta, Georgia, 1991.
Greenstein, Hsieh, Danielson, Phillips, Lueder: Intra-examiner Reliability Using the Flexicurve to Determine Lumbar Lordosis, Sagittal Mobility, and a Range of Motion Index. Proceedings of the 1991 International Conference on Spinal Manipulation. Washington, D.C., May 11-12, 1991.
Danielson, Hsieh, Greenstein, Phillips: Relationship of Body Discomfort to Duration of Sitting. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Greenstein, Hall, Danielson, Hsieh, Phillips: Flexicurve Validity. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Phillips, Danielson, et al., Spine Loading and Body Discomfort When Sitting at Two Backrest Angles and Three Support Depths. Proceedings of the Scientific Symposium, 1991 World Chiropractic Congress. Toronto, Canada, April 29-May 5, 1991.
Nansel, Peneff, Quitoriano: Effectiveness of Upper vs. Lower Cervical Adjustments with Respect to the Amelioration of Passive Rotational vs. Lateral-Flexion End-Range Asymmetries in Otherwise Asymptomatic Subjects. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Wong, Nansel: Comparisons Between Active vs. Passive End-Range Assessments in Subjects Exhibiting Cervical Range of Motion Asymmetries. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Nansel: Side-Specific and Level-Specific Effects on Spinal Adjustments on Cervical Lateral-Flexion and Rotational Passive End-Range Asymmetries. Proceedings of the Scientific Symposium, 1991 World Chiropractic Congress. Toronto, Canada, April 29-May 5, 1991.
Jose, Adams, Meeker: Three-Site Outcomes Assessment Demonstration Project: Status Report. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Jansen: A Representative Survey of American Chiropractors' Attitudes Toward Standards of Care. Proceedings of the 1991 International Conference on Spinal Manipulation. Arlington, Virginia, April 12-13, 1991.
Meeker: Advances in Manual Therapy Research. Proceedings of the Cervical and Lumbar Spine: State of the Art 1991 San Francisco Spine Institute Conference. San Francisco, March 23, 1991.
Shekelle, Adams, Chassin, et al., Spinal Manipulation for Low-Back Pain: Methods and Results of a Multidisciplinary Expert Consensus Panel. American Academy of Orthopedics Annual Meeting. Anaheim, California, March 1991.
Shekelle, Adams, Chassin, et al., Spinal Manipulation for Low-Back Pain: Methods and Results of a Multidisciplinary Expert Consensus Panel. Proceedings of the Sixth Annual Conference on Research and Education. Emphasis on Consensus. Monterey, California, June 21-23, 1991.

By the dates of publication, you get the clear indication that the CCR has built up a good head of steam in its research efforts: impressive strides for an organization in only the few short years it has been in existence. This is the organization whose members will continue to provide the chiropractic profession with much of its best research. With today's political and economic climate, such chiropractic research will be paramount in establishing our future.

For more information on the Consortium for Chiropractic Research and how you can become a member, please contact:

Consortium for Chiropractic Research
William Meeker, D.C., M.P.H., President
1095 Dunford Way
Sunnyvale, CA 94087
(408) 983-4067

February 1992