256 J Can Chiropr Assoc 2004; 48(4)

Canadian Chiropractic Researchers

Dr. Ted Crowther, DC, MSc

Dr. Ted Crowther graduated from the Canadian MemorialChiropractic College in 1982 and established practice inStoney Creek, Ontario. Like most of his classmates heconsidered a full and productive career in communityclinical practice. Comfortable in practice, but with a de-sire to continue training, he completed a one-time, fieldpractitioner program in clinical sciences and received hisFellowship from the College of Chiropractic Sciences in1993. “I really hadn’t intended to have a research compo-nent to my career when I graduated” explains Dr.Crowther. “My experiences in the Fellowship program

changed all that”. In 1993 he joined the Canadian Memo-rial Chiropractic College as a clinical faculty member. In1995 he was appointed Director of Clinical Education atCMCC, a position he holds today. Many of his publica-tions, awards and grants have come from researchprojects with CMCC students, residents and faculty.

A number of Dr. Crowther’s research initiatives havefocused on pediatric conditions. In conjunction with Drs.Sil Mior and Deb Kopansky-Giles of CMCC and Dr. JimWright of the Hospital for Sick Children, Toronto, hecompleted, during his Fellowship program, two studieson scoliosis measurement with results published in Spineand presented at the Canadian Orthopedic Research Soci-ety Conference.

In 1995 he teamed with Drs. Jeff Balon and Peter Akerof CMCC and respirologists Drs. Malcolm Sears andGerald Cox of St. Josephs Hospital/McMaster Universityin the development of a randomized control trial of chiro-practic treatment for chronic childhood asthma. Eventu-ally receiving almost half a million dollars in researchgrants, results of the trial went on to be published in theNew England Journal of Medicine in 1998.

In 1999 he joined a research group with Ron Feise, DC,of the American Chiropractic Scoliosis Research Society(ASRS), and Dale Rowe, MD, FACS, Kalamazoo Centerfor Medical Studies and Michigan State University andChair, Non-Operative and Bracing Committee of theAmerican Scoliosis Society to develop a more compre-hensive scoliosis research program. Although the resultsof the asthma study were negative, Dr. Crowther feels thatmuch of the feasibility of this current initiative came out ofthe asthma study. “There were two things that convincedthe Scoliosis Research Society to partner with us in theseinitiatives; chiropractor’s abilities to perform high qualityresearch and the willingness of funding agencies such asthe National Institutes of Health to begin funding projectsin complementary and alternative medicine”.

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To that end this team has kicked off a number of ado-lescent idiopathic scoliosis (AIS) research initiatives.Recognizing the lack of a quality of life instruments inpre-surgical AIS children Dr. Feise and Dr. Crowther, inconjunction with Dr. Jim Wright of the Hospital for SickChildren and Dr. Michael Menke of the University of Ar-izona constructed and validated a quality of life index forpre-surgical AIS patients. This projected is completedand accepted for publication in Spine. The major goal ofthis research group is the funding and completion of alarge randomized controlled trial of chiropractic manage-ment for AIS. Dr. Crowther and the team knew early thatsuch a project would be large and expensive. In advanceof this project, a proof of concept, pilot study was de-signed and completed at the Kalamazoo Center for Medi-cal Studies (KCMS), Michigan State University. Fundedthrough $150,000 in internal grants from the KCMS,ASRS and CMCC, this study explored design issues andgenerated preliminary data in support of a full trial. “Welearned a great deal about what to do and what not to doin a full multi-site trial”. The pilot study manuscript iscurrently being completed and work on a full proposal isunderway.

Dr. Crowther says one of his most enjoyable researchactivities of has been in his involvement in the WorkplaceSafety and Insurance Board (WSIB) of Ontario Programsof Care initiatives. Programs of Care (POCs) are multi-discipline, multi-stakeholder clinical practice guidelinesdeveloped for the treatment of work related injuries. In-corporating literature search, critical review of the litera-ture, translation and consensus process, these POC’s aredesigned to reduce costs, reduce morbidity and disabilityand enhance stakeholder satisfaction. Beginning with oc-cupational asthma and acute low back pain, they havegone on to develop POC’s for persistent low back painand upper extremity injuries, among others. The processand implementation of the POC’s have been positive forthe chiropractic profession in Ontario as have the pro-gram outcomes.

In 2002, Dr. Crowther began a Masters of Science inHealth Services Administration at the School of Healthand Human Services, D’Youville College, Buffalo, NewYork. “I found myself increasingly working in largehealth care organization, yet understanding little aboutthe culture and operation of such organizations and thebroader health care environment” says Dr. Crowther.

“There is a point at which clinical research and care inter-sects with policy and economics. I thought this would bea good first step in beginning to explore the complexityof health care outside of the clinician or researcher per-spective.”

Not wanting to stray from his clinical roots, Dr.Crowther’s Master thesis compared the cost-utility of chi-ropractic and pharmacologic management of chronic lowback pain in adults. His supervisor was Dr. JudithSchiffert. While much of the research into the cost-effec-tiveness of chiropractic care has focused on disability,treatment or program costs, this study considered the costof improving the quality of life of patients with chroniclow back pain. Termed cost-utility analysis, it generatedquality adjusted life year scores (QALYs) from question-naires, where a QALY of one represents full or completehealth and a QALY of zero represents death. Althoughthe group receiving cox-2 inhibitors and the group receiv-ing chiropractic treatment were similar in age, duration ofpain and pain levels, there were significant differencesbetween the two. The group receiving pharmacologic in-tervention scored a QALY of .20 while the chiropracticgroup achieved a significantly better score of .51. Whilethe chiropractic group typically paid more out of pocketcosts for treatment than the pharmacologic group, thecost-utility ratios were favourable for the chiropracticgroup. The purchase of one QALY with chiropractic carewas $678, for the pharmacologic group it cost $988. Inthe end, the chiropractic group enjoyed higher quality oflife and lower average cost-utility when compared to thepharmacologic treatment group. “Although a preliminarystudy, it is research initiatives such as these that may havepolicy makers, payers and governments take a different,more favorable, look at chiropractic management ofchronic back pain” says Dr. Crowther.

Having completed his Masters in 2004, Dr. Crowther isnow pursuing his Doctor of Education (EdD) in HealthPolicy at D’Youville College. This EdD program, de-signed to focus on knowledge application, will providepreparation in research and analysis, policy formation,problem solving, organizational behavior, communica-tions, law and policy, and finance. Dr. Crowther looksforward to continuing his dissertation work in the area ofsocial welfare policy.

Dr. Crowther’s research track appears less common. “Itseems that chiropractic related research is increasingly

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performed by full-time researchers anchored to universitysettings. This is certainly an impressive development giv-en where we came from in the late seventies, early eight-ies. There is still a role for the clinician-scientistshowever; that clinician that combines an emphasis onteaching and clinical practice but with related researchactivities”. Juggling these different roles is not easy, but it

remains possible. Dr. Crowther credits much of his posi-tive research experience to exceptional mentors such asDrs. Mior and Feise and the financial and time support ofCMCC in his ongoing graduate studies. In the end it isabout developing strong, productive, multi-discipline re-search teams committed to completion of importantprojects.