RESEARCH

Evidence-based practice & practice based evidence

M OST CHIROPRACTORS that I speak to are in favour of research projects that generate evidence of effectiveness in what they do.

Most chiropractors are also happy to allow “the researchers” to do it. However, there are too few ‘researchers’, too little time and not enough funds: with the inevitable result that very little gets done.

Those of you who attended the British ChiropracticAssociation’s Spring conference on the 21st March will have heard of some practitioners’ experiences with ‘practice based research’.

Jonathan Cook DC, from Bristol, began a research project with two local Orthopaedic surgeons (Mr’s Gargan and Bannister) looking into the effectiveness of chiropractic manipulation on whiplash. Together they designed the project with help from Bristol University, and the combined results lead to some publications and presentations at local medical forums. Subsequently, the number of GP and Consultant referrals to Jonathan’s practice increased by 400%, and his weekly patient numbers increased by 100%.

Its not easy, and its not cheap, to achieve results like that, and Jonathan must be congratulated for some excellent work that resulted in some fine publications in the peer reviewed literature.

Jonathan says that he is a ‘normal field practitioner’. He is not. Through some effort and dedication he has become a researcher. He has established these results on the effectiveness of chiropractic manipulation on whiplash syndromes and, in so doing, has pushed the profession forward.

He is the ‘driver’ of the project, without which it would never have happened. He could see the benefits of what he was doing for his practice and financed the project

himself - vvith tremendous results. The College of Chiropractors aims to

continue to promote this type of work through the provision of expertise and, slowly but increasingly, through the actual provision of funding.

Mark Ellokland DC has also achieved some superb results in his work with local companies. By looking at absenteeism and working with low back pain questionnaires, he has demonstrated his effectiveness in the work place, improving employees health and decreasing absenteeism. Mark recruited the assistance of Jenni Bolton PhD, from the Anglo-European College of Chiropractic, who is also a consultant to the College of Chiropractor’s research division, and again funded the research himself.

His research costs have been paid back several tirnes over, as the continued contracts from these companies has also increased his chiropractic work load. Once again, instigating a seeing through a research project involved hard work, but he has achieved some excellent results beneficial to both his own practice and the profession as a whole. Mark has also been called upon to lecture on his work and aims to continue with further studies.

With the new department of health “healthy workplace initiative” this MUST be the way forward for many practitioners, and Marks studies have certainly paved the way.

The Research Division will provide the expertise, and is looking at possible funding initiatives - a recent, spontaneous collection at the BCA’s spring conference endorsed by an ‘anonymous backer’ who pledged to double what was collected, raised almost f 1200.

What is needed are the ‘drivers’: The practitioners to provide the ideas, and push the projects forward, using their own patient

base - even combining forces with other practices to share the work, the patients and combine results.

At the BCA conference Lou Bashall DC described her wishes to conduct some work into infantile colic - she is the rare exception as she has been offered funding in advance of the study. She plans to utilise the Specialist Faculty of Paediatrics of the College in order to substantially broaden her statistical base and is already liaising with the Faculty’s research co-ordinator.

There are a further four chiropractors that have approached us who are looking at practice based research. One of which is based on Jonathan Cooks model - looking into the effectiveness of their treatment , another on Mark Blokland’s model holding discussion with local companies. The other two are wishing to look at posture in the workplace and a survey of the chiropractic practices in the UK-just to establish who, and where, we are.

Its slow, but more and more practitioners are looking to themselves to provide the resource to ensure our place in the developing environment of healthcare.

Whether we like it or not we musf generate evidence of the effectiveness of what we do. There are a number of initiatives currently being promoted by the Department of Health I The National Institute for Clinical Excellence (NICE) is looking at the evidence of all aspects of health care. They will look at chiropractic and makes their recommendations base on evidence of effectiveness and co&effectiveness. It would be good for the profession if there were considerably more evidence available to effectively back the profession’s burgeoning reputation as the leading provider of spinal care.

30 The British Journal of Chiropractic, 1999, Vol 3 No. 2