1. of Chiropractic Clinical Research Palmer Center for Chiropractic Research

2. ...is to improve practice, not prove it.

3. Basic: investigates physiological mechanism(s) by which chiropractic works: WHY and HOW Clinical: investigates actual effects on patients: IF, WHEN and WHOM èBoth are necessary but each requires specialized skills to conduct.

4. Where are we now?

5. 41 RCTs of “smt” (some DC, some DO) 28: positive 13: equivocal 51+ systematic reviews—34+ positive Moderate evidence for acute and chronic LBP for short-term outcomes Insufficient evidence for LBP with sciatica

6. 11 RCTs 4 positive 7 equivocal 2 meta-analyses both positive “weak cumulative evidence”

7. 9 RCTs (3 for migraine) 7 positive (2 for migraine) 2 equivocal (1 for migraine) Evidence is mixed but promising for certain types of headache

8. 1 equivocal

9. Few case reports (<35 Medline) No observational studies Few experimental studies 9 RCTs for 6 conditions One systematic review: evidence not sufficient for or against any of these conditions at this time

10. ZERO!

11. Why don’t we have more and better evidence?

12. Current Refined RCTs Case Reports Other Observational Pre-exp./preliminary

15. Part 3: How do we build the evidence base?

16. RCTs Other Experimental Quasi-Experimental Observational Case reports/Clin. Observ. The Hierarchy of Evidence LESS convincing MORE convincing LAST! FIRST!

17. RCTs Other Experimental Quasi- Experimental Observational Case reports/ Clinical observations Evidence in Chiropractic LESS convincing MORE convincing FIRST/ MOST! Later if at all…

19. More and better: and

20. To build a stronger base: What works best for whom? Case reports on chiropractic care Observational studies Population based Practice based Preliminary and pilot studies to refine questions

21. Current Refined RCTs Case Reports Other Observational Pre-exp./preliminary Evidence base congruent with our practice and philosophy

22. What do we need to see in case reports? Publication in indexed peer-reviewed journals Reports of chiropractic care Details on techniques Details on frequency and duration Use of outcome assessments Reliable, valid, responsive Measure the outcome of interest

23. Building the evidence base in chiropractic…

24. Meta- Analyses RCTs Other Experimental Quasi-Experimental Observational Case reports/Clinical observations

25. Meta-Analyses RCTs Other Experimental Quasi-Experimental Observational Case reports/ Clinical observations

27. Case reports on specific care protocols and outcomes Pre-experimental studies refining questions  Refined RCTs congruent with chiropractic philosophy

28. Current Refined RCTs Case Reports Observational Pre-experimental

30. Write a case report describing chiropractic management in detail This helps refine research questions This provides evidence for proposing clinical experimental studies

31. Publication in indexed peer-reviewed journals Reports of chiropractic management Details on techniques Details on frequency and duration Use of outcome assessments Reliable, valid, responsive Measure the outcome of interest

32. if you don’t publish it... In the world of evidence- based practice,