Chiropractic College Research: Evidence as Validation
Written by Editor   
Friday, July 03, 2015 02:29 PM
Quick Brief:  Research is a critical need for the chiropractic profession, but for various reasons our profession is not thoroughly represented in the field of clinical research.  Competition for limited funding is keeping chiropractic research in the USA lagging behind several foreign countries.


Perhaps the greatest research weakness the chiropractic profession has is a lack of appreciation for just how important clinically-based, patient-oriented outcomes research will be in the near future as the U.S. health care system continues to evolve. “We have a real need to develop evidence-based best practices — not just to improve patient results but also to validate chiropractic for the benefit of payers and health policy makers,” says Dr. Lauretti. “Further real-world research is needed to demonstrate our worth.”

Top-level research supports and expands the credibility of the chiropractic profession. Research discoveries lead to new clinical applications, cross-disciplinary work and collaboration with other medical professionals and institutions. Successful research can also energize a DC’s approach to practice and improve patient outcomes. Countries like Denmark, Canada, Switzerland and Australia are conducting impressive clinical research studies that are filling gaps in our knowledge base and validating how we treat patients. 

More chiropractic research is emphasizing clinical outcomes. “It’s not enough to demonstrate to third-party payers that you have a reasonable biological mechanism for your care — they want to see evidence that it actually works in the real world with real patients,” says William J. Lauretti, DC, and associate professor of chiropractic clinical sciences at New York Chiropractic College in Seneca Falls, N.Y. 

Some chiropractic colleges have research departments; others leave it up to individual faculty members to pursue research projects. Regardless of the approach, what can be accomplished seems to be directly related to funding.  “If it takes a village to raise a child, it takes a small city to run a randomized clinical trial. Palmer has 30 people working full time on our research efforts. The college spends approximately seven percent of our annual budget [roughly $5 million] on research.” About half of that money comes directly from Palmer, with most of the rest coming from federal grants.

“Research universities and colleges are all driven, to some degree, by funding,” says David O’Bryon, executive director for the Association of Chiropractic Colleges in Bethesda, Md. “The federal government has cut back on funding, and chiropractic competes with everyone else for the reduced dollars. National Institutes of Health (NIH) funding is more limited now and the Health Resources and Services Administration (HRSA) has also fallen off as a resource.”  As a result, “federal funding for chiropractic research is increasingly competitive, at a time of overall decreasing available funds,” adds Mitch Haas, DC, MA, and associate vice president of research at the University of Western States in Portland, Ore. 

Another way to create funding is to pursue research projects that will generate revenue that can be reinvested in future research. To make ends meet, Dr. Haas notes, some senior research administrators at other institutions are restructuring their programs to require that any future research projects will be structured to be net income generators for their colleges.

A significant trend is the increase in high quality research coming out of Denmark, Canada, Switzerland and Australia. Chiropractic is completely integrated into these state university systems and collaborates with other disciplines. These advancements are possible because the national chiropractic associations and/or federal governments are making serious efforts to support chiropractic research, including significant government funding. In fact, the Danish government supports chiropractic research by paying for the education of DCs who want to earn PhDs — even providing them with a living-wage stipend during their education.  In Canada, the Canadian Chiropractic Association has been successful in helping DCs get PhD positions at major provincial universities. 

Most chiropractic colleges tend to be modeled more after liberal arts colleges, with a focus on teaching and community service, rather than major research universities, where faculty are considered researchers first and teachers second. “Therefore it is more difficult for chiropractic colleges to develop a ‘critical mass’ of accomplished researchers who can mentor the next generation and build on each other,” indicates Dr. Lauretti.  Even though the colleges may have opportunities for clinical research through their outpatient clinics, they typically don’t have the expertise for designing and running a quality clinical research study.  “Teaching/clinic loads are too heavy and research training and experience are too limited,” says Dr. Haas. “

For schools that are determined to expand their research capabilities, the first step is providing the necessary guidance and training regarding study design, statistical measures, etc.   Another way to gain this knowledge is by utilizing the expertise and resources of other research institutions through partnerships that share research goals. “Palmer has been very fortunate in working with established scientists at research intensive universities who are interested in collaborating with chiropractic scientists to answer questions that are directly relevant to the delivery of chiropractic care,” says Dr. Goertz.