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Translating research into better health

Palmer is at the forefront of translational research in chiropractic
Research often begins with a question posed by one or more scientists. But with a new approach to health research, questions and observations are being considered not only by scientists, but by those who benefit from its results—doctors and ultimately, the patients they care for.

Known as “translational research,” this research is driven by the premise that to improve human health, scientific discoveries must be translated into practical, everyday applications. While translational research has made inroads in the field of medicine, Palmer College is taking the lead in applying translational research to the field of chiropractic.
Translational research defined

In translational research, findings from laboratory, clinical or population studies are transformed into clinical or population-based applications to improve health by reducing disease incidence, morbidity and mortality.

By its collaborative nature, translational research is mutually beneficial to scientists and clinicians alike. While clinicians benefit from the new tools that scientists are giving them, the clinicians are in turn able to pass their own observations back to the scientists, who then generate further investigation.

The push for translational science and research began in 2002 at the National Institutes of Health—or NIH—which is part of the U.S. Department of Health and Human Services. By 2005, NIH Director Elias Zerhouni, M.D., was proclaiming that it was time for the research community “to translate the remarkable scientific innovations we are witnessing into health gains for the nation.”

Interest in translational research soon caught on at Palmer College. Last year, the College began drafting “The Palmer Vision,” a document that sets a fiveyear course for Palmer, including the Palmer Center for Chiropractic Research (PCCR). According to Executive Director for Research Christine Goertz Choate, D.C., Ph.D., “As part of the visioning process, we held a series of planning sessions and determined together that pursuing translational research in chiropractic fit right into Palmer’s vision.”

Funding for the future of chiropractic research
Palmer’s Executive Director for Research Christine Goertz Choate, D.C., Ph.D.
Dr. Christine Goertz Choate

Along with being the first chiropractic college to pursue translational research, Palmer is also the first to be awarded federal funding to implement it. In June, the Palmer Center for Chiropractic Research received funding of up to $2.63 million from the National Center for Complementary and Alternative Medicine, or NCCAM—a component of the NIH—to establish the Developmental Center for Clinical and Translational Science in Chiropractic.

Said Dr. Goertz Choate, “This grant award makes possible the next logical step in the development of the PCCR as we move beyond the strong platform we are building in basic science research toward our over-arching goal of establishing a strong translational research center for chiropractic.”

 
NCCAM Director Josephine Briggs, M.D., speaking to Palmer’s Research Department on a May 2008 visit to the Davenport Campus.
Dr. Josephine Briggs speaking

NCCAM Director Josephine Briggs, M.D., visited the PCCR this spring to tour the facility. “We need to support translational research to build a strong evidence base for complementary and alternative medicine,” said Dr. Briggs. “Only when that evidence base is constructed will we have the information that the public and practitioners need. I commend Palmer for leading this effort in chiropractic research.”

DCCTSC: Working together for the common good

The Developmental Center for Clinical and Translational Science in Chiropractic, or DCCTSC, is a fouryear, multidisciplinary consortium of complementary and alternative healthcare institutions that are joining forces for research. It is the fourth developmental center awarded by the NIH to Palmer since 1997.

The new center was created to promote greater communication and collaboration among 10 investigators at Palmer and their partners at the University of Iowa, the University of Miami, Chicago’s Loyola University Stritch School of Medicine and Edward Hines Jr. Veterans Affairs Hospital.

The DCCTSC is being led by Dr. Goertz Choate, its principal investigator, and contains three projects, ranging from a study on the effects of upper cervical manipulation on hypertension to a study that explores the feasibility of having a “placebo adjustment” when conducting chiropractic research.

Project 1: Hypertension and the NUCCA Technique

A recent pilot study in the Journal of Human Hypertension found that a chiropractic technique developed by the National Upper Cervical Chiropractic Association (NUCCA) was effective in lowering high blood pressure within a small group of hypertension patients. This method of adjusting the atlas subluxation complex is based on three-dimensional X-ray studies that determine the correct line of drive or vector of force.

The PCCR is expanding on the study under the co-direction of Dr. Goertz Choate and Gervasio Lamas, M.D., a cardiovascular scientist at the University of Miami. Dr. Lamas is known for his expertise in large, complex, multi-site clinical trials.

“We chose to replicate the pilot project because if the findings are reproducible, the results could have broad public health importance,” said Dr. Goertz Choate. “More than 50 million Americans suffer from hypertension, and any new treatment that has the potential to benefit patients with high blood pressure should be carefully evaluated.”

Because the NUCCA Technique is not widely used by chiropractors, toggle recoil will also be evaluated in the study.

“Despite the wide availability of effective treatments, only about 30 percent of hypertensive patients achieve blood pressure goals,” said Dr. Goertz Choate. “Therefore, there is a need to investigate alternative treatments that are not subject to the limitations of traditional therapies.”

Project 2: Help for people with jaw pain

Many people suffer from temporomandibular disorders (TMD), which encompass a wide variety of problems including difficulty in opening or closing the mouth or pain in the jaw. In some cases, people have significant levels of constant pain and/or mechanical dysfunction. While numerous approaches have been used in an effort to treat TMD, none of them have been shown to work very well.

A few years ago, one chiropractic technique, Activator Methods, appeared to have good results with patients who had TMD. In a small case series study of nine people with TMD, each of whom were treated with the Activator, all showed marked improvement.

PCCR Associate Professor James DeVocht, D.C., Ph.D., attaches a surface electromyographic (EMG) electrode to monitor the activity level of muscles in the neck.
Dr. James DeVocht attaching electrode on participant

These encouraging results led to the PCCR’s current four-year study on TMD. It is being co-directed by PCCR Associate Professor James DeVocht, D.C., Ph.D., Davenport ’83, and Clark Stanford, D.D.S., Ph.D. Dr. Stanford is the associate dean for Research and director of the Office of Clinical Research and the Dental Clinical Research Center of the University of Iowa’s Institute for Clinical and Translational Sciences.

This study will involve 80 participants with TMD to compare Activator Methods to splint therapy, the approach most commonly used by dentists. The Activator Methods care will be provided by Walter Schaeffer, D.C., Davenport ’86, who is the primary developer of the TMD aspect of the Activator technique. The splint therapy care will be provided at the University of Iowa.

“If all goes well and the results continue to be promising, the next step would be to request funding for a full-scale randomized control trial involving a larger number of participants and more than one treatment location,” said Dr. DeVocht.

Project 3: A placebo for chiropractic

The third DCCTSC project involves the development of a sham chiropractic procedure for neck pain that would play a role similar to a placebo pill in pharmaceutical studies.

PCCR Associate Professor Ram Gudavalli, Ph.D., left, observing PCCR Senior Clinician Robert Vining, D.C., as he gets into proper position to demonstrate distraction of the lower cervical spine.
Dr. Ram Gudavalli, seated, observes Dr. Robert Vining

“It is a challenge for chiropractors to develop sham procedures because the treatments involve manual contact with the patient,” said PCCR Associate Professor M. Ram Gudavalli, Ph.D. Dr. Gudavalli is co-leading the project with Avinash G. Patwardhan, Ph.D., professor at the Loyola University Stritch School of Medicine in Maywood, Ill., and director of the Musculoskeletal Biomechanics Laboratory at Edward Hines Jr. Veterans Affairs Hospital in Hines, Ill. Past collaborations between the two have resulted in research on neck pain, low back pain and biomechanics.

“The ideal sham procedure should not have any therapeutic effect, and at the same time, the patients should believe that they are receiving treatment,” said Dr. Gudavalli. “This allows us to directly compare active treatment with a placebo treatment so that we can learn more about the specific patient benefit received from the active treatment.”

In order to ensure the study’s success, only individuals who have not received this type of adjustment before will be considered for the study, as experienced patients would know firsthand the difference between a placebo adjustment and a real one.

Translational research at the campus level

The PCCR involves research on all three of Palmer’s campuses. In addition to faculty clinicians, students on the Davenport Campus and West Campus often take part in various research studies, a trend that is expected to evolve even further as the Florida Campus expands its research efforts over the next year.

Davenport Campus assisting students with Toggle Recoil project
PCCR Associate Professor Edward Owens, D.C., shows how to deliver a thrust on a speeder board, which, when fitted with a transducer, can measure the thrust and force of adjustments made in Toggle Recoil classes.
Dr. Edward Owens with hands on speeder board

In a recent study, Drs. DeVocht and Gudavalli, along with PCCR Associate Professor Edward Owens, D.C., collaborated with Toggle Recoil Instructor Ramneek Bhogal, D.C., Davenport ’02, and Department Technique Chair John Strazewski, D.C., Davenport ’79. They created a force/time profile of both upper cervical technique students and instructors when they delivered thrusts on a small device called a “speeder board.”

A speeder board has a drop mechanism like the headpiece of a toggle table, which is used by toggle students to practice delivering thrusts. For this study, a force transducer was placed within a speeder board and its output fed into a computer. The data from each thrust was then mapped out on a graph—similar to how a seismograph measures earthquakes—with the peak showing the maximum force of the thrust. Additional data will allow for quantitative analysis to be done later.

Because toggle recoil adjustments must be delivered both quickly and with the right amount of force, this approach is expected to become an important tool for helping chiropractic students improve their skills. Plus, a new journal club has been formed to review similar work by other researchers and to discuss how to best utilize this technology for technique classes.

West Campus acute neck pain study yields results

Neck pain is a condition that, according to some studies, affects almost half of the U.S. population. Acute neck pain—or ANP—is a sudden onset of neck pain, which has been present for a short period of time. It’s often caused by whiplash or sports injuries and, in time, may progress to the sub acute and chronic phases.

West Campus Director of Technique and Research Robert Cooperstein, D.C., left, and Associate Professor Michael Haneline, D.C., M.P.H., who both worked on the acute neck pain study in the West Campus Research Lab.
Dr. Robert Cooperstein at computer with Dr. Michael Haneline

“Very little information has been published on ANP, including its treatment with chiropractic care, yet chiropractors commonly treat the condition,” said Associate Professor Michael Haneline, D.C., M.P.H., who has been leading a study on ANP since 2004. “It is a difficult study to pursue because acute neck pain can progress from acute to sub acute to chronic within weeks.”

The recently completed study involved a network of practicing chiropractors who collected data on their ANP patients before forwarding it to the West Campus research center for analysis. The findings are expected to be submitted to peer reviewed journals by early fall. While no control group was utilized in this study for comparison, and no claims of cause and effect can be made based on its results, the study provides valuable information on chiropractic and ANP.

“As far as the potential benefits of this study, it will mainly provide previously unknown information about how ANP patients respond to chiropractic care,” said Dr. Haneline. “This is important and useful information to have and will lay the groundwork for future studies on chiropractic care for ANP.”

Florida Campus to build cell and molecular biology lab

Currently there is little knowledge available on how chiropractic works at cellular and molecular levels. But a new cell and molecular biology lab planned for the Florida Campus may show how chiropractic may work on some aging-related diseases and provide the scientific mechanisms behind it.

Florida Campus Director of Research Dr. Liang Zhang is spearheading a new cell and molecular biology lab.
Dr. Liang Zhang, seated at desk, speaking

“The aging population is growing rapidly in this country,” said Liang Zhang, M.D., Ph.D., who recently became the director of Research on the Florida Campus. “Thus, aging issues are increasingly important to people, for both prevention and treatment.”

Dr. Zhang chose to join Palmer after working for several years in pharmacology at the University of Illinois at Chicago College of Medicine. “I like the concepts of surgery-free and drug-free preventive care advocated by chiropractic,” said Dr. Zhang. “And Palmer is the leader in chiropractic.”

He also believes the work that will be performed in the new lab compliments the College’s venture into translational research.

“If a scientist wants to know more about chiropractic care as it is delivered in the practitioner’s office, he or she can team with field doctors for a clinical study,” added Dr. Zhang. “Or if a field doctor is interested in answering mechanistic questions, he or she can come to our lab to get their feet wet. Our plan is to both facilitate our understanding of chiropractic and disseminate effective techniques in field practice.”

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